HIFU联合超声微泡增效剂SonoVue治疗盆腔手术史子宫肌瘤患者研究

A Retrospective Study:High Intensity Focused Ultrasound (HIFU) Associated A Microbubble-enhancing Contrast (“SonoVue”) Therapy for Uterine Fibroids with Pelvic Operation History

目的探讨实时超声监控下HIFU联合超声微泡增效剂(SonoVue)治疗子宫肌瘤伴盆腔手术史患者的安全性与有效性.方法分析2010年10月至2012年12月宁市中心医院50例子宫肌瘤伴盆腔手术史患者行HIFU联合SonoVue治疗情况,与同期50例无盆腔手术史子宫肌瘤患者进行比较,观察患者治疗中肌瘤非灌注区体积、体积消融率、消融强度、消融剂量、在室时间、治疗时间及治疗后即刻不良反应与远期并发症等.结果手术史组非灌注区体积、体积消融率、消融剂量与非手术史组比较,差异无统计学意义(P>0.05);手术史组消融强度明显低于非手术史组(P<0.05);手术史组在室时间、治疗时间明显长于非手术史组(P<0.05);手术史组治疗中重度及以上疼痛率为46%,明显高于非手术史组20%(P<0.05),2组均无因难以忍受疼痛而终止治疗者.手术史组治疗后下腹部疼痛、皮肤烫伤、骶尾部疼痛明显高于非手术史组(P<0.05),后期随访两组患者均无严重不良反应.结论盆腔手术史增加了HIFU治疗子宫肌瘤操作难度;初步研究提示严格掌握适应症与禁忌症,HIFU联合SonoVue治疗盆腔手术史子宫肌瘤患者也可得到安全有效的治疗.

Objective To evaluate the feasibility of high intensity focused ultrasound （HIFU） associated microbubble-enhancing contrast （＂ SonoVue＂） therapeutic ablation of uterine fibroids in patients with pelvic operation history. Methods A total of 100 patients with uterine fibroid from October 2010 to December 2012 in Suining Central Hospital of Sichuan were treated with I-IIFU associated SonoVue. Among them, 50 patients had pelvic operation history. The no-perfused volume, median fractional ablation, ablation power rate, ablation dose, treatment time and adverse reaction were recorded. Results There was no statistical significance between patients with operation history and without in no-perfused volume and ablation does. The ablation power was lower in patients with operation than without. The treatment time and room time were longer in patients with operation than without. The adverse reactions were higher in patients with operation than without, especially skin pain and lowerabdominal pain （P 〈 0.05） . According to short and long-term follow-up results, no major complications were observed in any patients. Conclusion Pelvic operation history increases the difficulty in treatment of HIFU ablation uterine fibroids. HIFU associated contrast agent SonoVue ablation can be considered a safe and feasible approach to the management of uterine fibroids in patients with pelvic operation history after grasping the indications and contraindications.