不同因素对子宫肌瘤HIFU治疗疗效影响的初步分析

Preliminary analysis on the influence of different factors on the curative effects of high intensity focused ultrasound treatment of hysteromyoma

目的:探讨影响子宫肌瘤高强度聚焦超声(HIFU)治疗疗效的多种因素及相关性,为进一步优化治疗、预测治疗疗效提供理论依据。方法:选取接受HIFU治疗子宫肌瘤患者43例(59个肌瘤),HIFU治疗前1周行常规超声、超声造影及核磁共振增强检查,治疗后4～8周内行常规超声、超声造影检查。据治疗后4～8周内超声造影结果分为显效、部分有效和无效三个等级。据患者年龄、靶皮距、肌瘤位置、肌瘤类型、肌瘤体积、二维超声回声强度、超声造影强度分组,行HIFU治疗显效率比较。结果:59个经HIFU治疗的子宫肌瘤中,显效37个,部分有效20个,无效2个。单因素分析:患者年龄<45岁者和≥45岁者、靶皮距5～7 cm者和≥7 cm者、前壁或平前位子宫宫底部肌瘤与后壁或后位子宫宫底部肌瘤、肌壁间肌瘤与非肌壁间肌瘤、体积<65 cm3者与体积≥65 cm3者HIFU治疗显效率差异有统计学意义(P<0.05),超声造影高增强型、等增强型和低增强型总体HIFU治疗显效率差异有统计学意义(P<0.05)。二维超声回声强度对HIFU治疗显效率的影响差异无统计学意义(P>0.05)。进一步行多因素分析发现:靶皮距、肌瘤位置、肌瘤类型、超声造影强度与HIFU治疗显效率相关(P<0.05),而患者年龄和肌瘤体积与HIFU治疗显效率无关(P>0.05)。结论:患者年龄、肌瘤体积、靶皮距、肌瘤位置、肌瘤类型和超声造影强度对子宫肌瘤HIFU治疗显效率有影响,其中后四者是独立影响因素。

Objective： To explore the factors that affect the high intensity focused ultrasound （HIFU）treatment of hysteromyoma and analyse the relativity between various factors and curative ettects ot HIFU treatment of myoma. To provide the theoretical basis which can optimize further therapies and forecast curative effects. Methods： A total of 43 patients with myoma （59 myomas in total） were enrolled into this study. All patients were examined by routine, contrast-enhanced ultrasonography and MRI one week before HIFU treatment. Then routine and contrast-enhanced ultrasonography were performed within 4～8 weeks after treatment. Curative effects were divided into three grades： excellent, effective and ineffective according to the results of contrastenhanced ultrasonography 4-8 weeks after treatment. The data were divided into groups according to the patient＇s age, the target-skin distance, hysteromyomas location, type, volume, the echo intensity of two-dimensional （2-D） ultrasonography and the intensity of contrast-enhanced ultrasonography, respectively. Then the significant efficiency of HIFU treatment was analyzed. Results： In 59 myomas, 37 were excellent, 20 were effective and 2 were ineffective.Univariate analysis revealed that： curative effects had significant difference between patients age 〈 45 years and ≥ 45 years （P 〈 0.05）, the target-skin distance 5-7 cm and ≥ 7 cm, different positions of myomas （in the front wall or at the bottom of flat or former uterus and in the back wall or at the bottom of posterior uterus）, intramural myomas and non-intramural myomas, myoma volume 〈 65 cm3 and ≥ 65 cm3, the contrast-enhanced type （high-enhanced, iso-enhanced and low-enhanced type）. The effect of different echo intensity of 2-D ultra sound on the treatment had no significant difference （P 〉 0.05）. Further multivariate analysis found that： the target- skin distance, the location of myoma, the type of myoma and contrast-enhanced ultrasonographic intensity were associated with HIFU treatment efficiency （P 〈 0.05）. However, the age of patients and myoma volume were irrelevant with HIFU treatment efficiency （P 〉 0.05）. Conclusion： The age of patients, myoma volume, the target-skin distance, myomas location, type of myomas and contrast-enhanced ultrasound intensity all affect the HIFU treatment efficiency of myomas. The last four items are independent factors.