影响子宫腺肌病超声消融疗效相关因素分析

Analysis of related factors of the efficacy of the treatment of adenomyosis with high intensity focused ultrasound

目的分析影响高强度聚集超声(HIFU)消融治疗子宫腺肌病近期结果的相关因素。方法随访中南大学湘雅三医院2012年4-12月40例经HIFU治疗的子宫腺肌病患者治疗前后临床症状改善情况及治疗后3个月子宫缩小率。通过单因素及多因素相关分析探讨年龄、子宫位置、病灶位置、病灶血流情况、病灶弥漫程度、治疗后灰度变化及消融比例对治疗后症状改善及子宫缩小率的影响。结果 40例患者临床症状改善率75%,治疗后3个月子宫缩小患者所占比例为88.9%。病灶局限及血流不丰富的患者临床症状改善情况明显优于病灶弥漫及病灶血流丰富患者(P<0.05),其中消融比例高、消融后发生整体灰度变化者子宫缩小更明显(P<0.05)。治疗中及治疗后均无并发症发生。结论子宫腺肌病HIFU治疗后症状改善率及子宫缩小率与病灶弥散程度、病灶血流情况、消融比例及消融后灰度变化情况有关。

Objective To investigate the influencing factors of the short-term results of high intensity focused ultrasound （HIFU） for adenomyosis. Methods Symptom improvement and the shrinkage of the size of the uterus at 3 months after HIFU were evaluated. The relationship between the symptom improvement, shrinkage of the size of the uterus and age, u- terus position, lesion location, blood supply of the lesion, grey scale changes, as well as the non-perfused volume （NPV） ratio were analyzed. Results Symptom improvement observed in 75 % of the 40 patients and 3 months after the treatment, 27 patients completed the ultrasound evaluation,and the shrinkage of the uterus occurred in 88.9% of them. Symptom improvement was observed more in patients with focal adenomyosis than those with diffuse adenomyosis （P 〈 0. 05 ）, also more in lesions with poor blood supply than with rich blood supply. The shrinkage of the uterus was more in patients with higher NPV ratio than with less NPV ratio, as well as in patients with massive grey scale changes than with- out （ P 〈 0. 05 ）. No complication was observed in this study. Conclusion Symptom improvement and the shrinkage of the uterus are associated with the focal adenomyosis, blood supply of the lesion, the NPV ratio, as well as the grey scale changes. These factors can be used to guide the treatment of adenomyosis.