子宫肌瘤单次整体超声消融治疗无效原因分析

Analysis on the causes of poor treatment effect of uterine fibroid tumors with high intensity focused ultrasound

目的:分析单次整体体外超声消融治疗子宫肌瘤效果不佳的原因和解决的办法。方法:对子宫肌瘤单次整体高强度聚焦超声(HIFU)治疗效果不佳后行手术治疗的5例患者治疗资料及术中所见、术后组织病理检查结果进行回顾性分析,并复习相关文献。结果:本组HIFU治疗平均功率362~400W、辐照时间998~2947s、治疗剂量398500.0J^1178800.0J、治疗强度789~1091s/h;HIFU治疗后11~16个月症状改善不明显,核磁共振检查或超声检查提示瘤体未明显缩小或稍增大,HIFU治疗后至手术时间为11~22个月;其中4例患者行子宫肌瘤剔除手术,1例患者行全子宫切除术。超声所见:子宫浆膜层光滑,与盆腔脏器、腹膜均无粘连,受照子宫肌瘤病灶中心1/2~4/5区域均为灰白色干酪样或乳状坏死,瘤体表层1/5部位见粉色典型螺旋状平滑肌组织结构、质地较软,部分呈囊性变;子宫浆膜层、子宫肌层及子宫内膜外观正常。术后病理检查提示:瘤体组织为平滑肌组织或有透明变性,无恶性病变组织。结论:肌瘤的部位、瘤体血供及治疗能量是影响HIFU疗效的重要因素,个体化治疗是HIFU成功的原则,彩色多普勒检测具有指导意义。

Obje＆ive：＇To analyze the reasons and solutions for the ineffectiveness of single integral HIFU ablation in vitro for uterine fibroids. Methods： 5 cases of uterine fibroids treated by single integral HIFU ablation with poor outcome and subsequently treated by surgeries were analyzed retrospectively with regards to the HIFU treatment information, operative findings and post operational pathology. And the related literatures were reviewed. Results： In this group, the average power was 562W-400W, the radiation time was 998s-2947s, the treatment dose was 398500.0J-1178800.0J, and the treatment intensity was 789s/h-1091s/h; 11-16 months after HIFU, the symptom improvement was not obvious, MRI or US suggested that the tumor volume had not significantly decreased or increased slightly, the interval between HIFU treatment and surgery were 11-22 months; 4 patients had hysteromyomectomy and 1 had panhysterectomy. During operation, the uterine serosa were all smooth, had no adhesion with adjacent organs or peritoneum, 1/2-4/5 of the center area of the fibroids under radiation was gray caseous necrosis or emulsion necrosis, 1/5 of the tumor surface can see typical pink spiral smooth muscle tissue structure with soft texture, and part with cystic degeneration; the appearance of the serosa, myometrium and endometrium of the uterus were normal; postoperative pathologic examinations showed the tumor tissue was smooth muscle tissue or had hyaline degeneration, with no malignant tissues. Conclusion： The location of the fibroids, rich blood supply and the treatment dose are important factors that affect the efficacy of HIFU, individualized treatment is the principle of success, CDFI has instructive significance.