高强度聚焦超声治疗子宫黏膜下肌瘤

High-intensity focused ultrasound in treatment of submucosal fibroid

目的观察高强度聚焦超声(HIFU)治疗子宫黏膜下肌瘤的效果及其所致子宫内膜损伤对疗效的影响。方法对58例子宫黏膜下肌瘤患者行HIFU治疗。根据MRI计算HIFU治疗后消融率,评价疗效;比较治疗后内膜完整与内膜损伤患者消融率的差异。应用彩色多普勒超声比较HIFU治疗后1、3、6个月内膜完整与内膜损伤患者的肌瘤缩小率;治疗后6个月随访患者月经量改善情况。结果 HIFU治疗子宫黏膜下肌瘤有效率为100%(58/58)。治疗后内膜完整31例,内膜损伤27例,二者肌瘤消融率差异无统计学意义[(67.17±17.02)%vs(73.38±17.29)%,P>0.05];治疗后1、3、6个月肌瘤缩小率分别为(28.57±13.00)%、(45.38±16.54)%、(57.52±17.59)%和(37.81±17.21)%、(56.59±19.15)%、(71.31±16.21)%,差异均有统计学意义(P均<0.05);内膜损伤患者月经改善率(96.30%)高于内膜完整患者(77.42%,P<0.05)。结论 HIFU治疗子宫黏膜下肌瘤临床疗效显著,治疗时损伤部分子宫内膜有利于肌瘤排出或缩小以及缓解症状。

Objective To evaluate the efficacy of high-intensity focused ultrasound （HIFU） for treatment of submucosal fibroid, and to explore the influence of ablation-induced endometrium damage on therapeutic effect. Methods Totally 58 patients with submueosal fibroid underwent HIFU ablation. The ablation rates were calculated to obtain effective rate ac- cording to MRI results, and were compared between patients with intact endometrium and injured endometrium. The de- creased rates of fibroid according to CDFI and improvement of menstrual amount were evaluated 1, 3 and 6 months after ab- lation. Results HIFU ablation was effective in all patients （58/58） with effective rate of 100G, including 31 with intact endometrium and 27 with injured endometrium. There was no statistical difference of ablation rate （[67.17 17.02]% vs [73.38± 17.29]%, P〉0.05） between patients with intact and injured endometrium. The decreased rate of fibroid in pa- tients with intact and injured endometrium 1, 3 and 6 months after ablation were significantly different （[28.57±13.00] vs [37.81± 17.21]%, [45.38±16.54]% vs [56.59±19.15]%, [57.52±17.59]% vs [71.31±16.21]%, all P〈 0.05）. The improvement rate of menstrual amount was higher in patients with injured endometrium （96.30 % ） than that in patients with intact endometrium （77.42%, all P〈0.05）. Conclusion HIFU ablation is effective in treatment of submu- cosal fibroid. The damage of partial endometrium is beneficial to excrete the fibroid, reduce fibroid volume and relieve symptoms.