超声引导经皮微波消融治疗子宫黏膜下肌瘤临床疗效观察

Effectiveness of ultrasound-guided percutaneons microwave ablation in treating submucous fibroids ： a clinical trail

【摘要】目的评价超声引导经皮微波消融（UPMWA）治疗子宫黏膜下肌瘤的临床疗效。方法对19例经UPMWA治疗的子宫黏膜下肌瘤患者进行临床疗效评价的前瞻性研究。在术后3、12个月患者来院复查时，记录肌瘤体积、血红蛋白量（Hb）、子宫肌瘤症状及与健康相关生活质量（UFS—QOL）评分以及副作用、并发症，并同治疗前相应指标相比较。结果19例患者的19枚黏膜下肌瘤中，0型5枚、I型6枚、Ⅱ型8枚。消融后8例患者有坏死组织排出，肌瘤体积、Hb及UFS-QOL的症状严重程度评分（SSS）和健康相关生活质量评分（HRQL）分别从治疗前的（78．75±65．71）cm3、（89．50±21．34）g／L、（36．34±17．65）分及（54．38±25．60）分变化至消融后12个月的（11．13±8．78）cm。（P=0．000）、（124．60±14．00）g／L（P=0．000）、（15．30±13．58）分（P=0．000）及（83．35±12．28）分（P=0．000）。患者主要不良反应为阴道流液，在治疗后2～4周内多数患者症状可自行消失，未出现严重并发症。结论UPMwA治疗子宫黏膜下肌瘤临床效果确切，成为其保守治疗可供选择的方法。

Objective To evaluate the efficiency of ultrasound-guided percutaneous microwave ablation （UPMWA） in treating submueous uterine fibroids. Methods 19 patients with 19 submucous uterine fibroids were admitted from March 2009 to December 2012. Microwave antenna was inserted into the centre of fibroid percutaneously and work in a reasonable energy. After ablation, contrast enhanced ultrasound （CEUS） and contrast enhanced magnatic resonance imaging （ce-MRI） were performed to evaluate the situation of fibroids and surrounding organs. Then fibroidrs volume, hemoglobin level and the score of uterine fibroid symptom and quality of life （UFS-QOL） were recorded at pre-ablation,3- and 12- months after ablation. Side effects and complications were also assessed. Results 5 fibroids was identified as type 0,6 as type I and 8 as type II. 8 of 19 patients had discharged necrotic tissues from vagina. Fibroid- volume,hemoglobin concentration, the score of symptoms severity score（SSS） and health related quality of life （HRQI.） changed from （78.75 ± 65.71）cm3 , （89.50 ± 21.34）g/L,36.34 ± 17.65 and 54.38 ± 25.60 to （11.13±8.78） em3（ P = 0.000）,（124.60 ± 14.00）g/L （ P = 0.000）,15.30 ± 13.58 （ P = 0.000） and 83.35 ± 12.28 （ P = 0. 000） respectively. The main side effect is excessive fluid from vagina, most of the patients＇ fluid disappeared within 4 weeks after UPMWA, no major complications occurred after ablation. Conclusions UPMWA is a feasible,effective and safe therapy for submucous fibroids.