超声引导下射频消融术治疗子宫肌瘤的疗效观察

Evaluation on the effect of radiofrequency ablation for the treatment of hysteromyoma using color doppler ultrasound

【目的】探讨彩色多普勒超声在射频消融(RFA)子宫肌瘤疗效观察中的应用价值。【方法】应用彩色多普勒超声观测201例子宫肌瘤患者在RFA术前、术后6个月时的子宫及肌瘤大小、形态、内部回声变化;观察血流状况,并测量子宫动脉、肌瘤周边动脉的阻力指数的变化。【结果】RFA术前子宫平均体积为(252.3±51.5)cm3,肌瘤平均体积为(52.3±26.1)cm3。RFA术后6个月子宫平均体积为(145.8±38.7)cm3,缩小42.46%,与术前比较有显著差异(P<0.01);肌瘤体积(21.8±9.5)cm3,缩小59.62%,与术前比较有显著差异(P<0.01)。术前肌瘤周边有晕环,血流丰富;术后晕环消失,肌瘤周边及内部血流消失。术前子宫动脉RI为(0.70±0.08),术后6个月子宫动脉RI为([0.84±0.09),P<0.01],恢复正常。治愈108例(53.73%),显效59例(29.35%),有效32例(15.92%),无效2例(1.00%),总有效率99.00%。【结论】彩色多普勒超声能够观测RFA治疗前、后子宫及子宫肌瘤大小的变化,并能观测子宫及子宫肌瘤血供的变化,是评价RFA治疗子宫肌瘤的有效方法。

[ Objective ] To evaluate the curative effect of radiofrequency ablation（RFA） for treating hysteromyoma using color Doppler imaging. [ Methods] Two hundreds and one patients with hysteromyoma were examined with color Doppler imaging regularly before and after RFA within six months. The size , morphology, internal echo texture and Doppler signals of the uterus and its myoma were observed and Doppler indices of the uterine artery, peripheral and internal vascular blood flow in myomas were measured. [ Results] There were significant differences of the average volume of the uterus and its myoma between pre-operation and post-operation, i （252.3 ± 51.5）cm3 vs（ 145.8 ± 38.7）cm3, （ 52.3 ± 26.1）em3 vs （21.8 ± 9.5）cm3, respectively, （P 〈 0.01）.The resistance index of the uterine artery was increased instantly after ablation （RI 0.92 ± 0.1 lvs 0.70 ± 0.08,P 〈 0.01 ）, as compared with that of preoperation, and at 6 months after RFA, the RI of the uterine artery became normal（RI 0.84 ± 0.09）. There was rich blood flow in the peripheral region of the myoma before RFA. After RFA no blood flow was displayed in the peripheral of the myoma. The total effective rate was 99.00%. [Conclusions] Color Doppler imaging is an effective evaluation method for RFA of hysteromyoma.