肌壁间、粘膜下与浆膜下子宫肌瘤超声消融疗效比较及12个月随访结果

Ultrasound- guided focused ultrasound ablation of intramural, submucosal and subserosal uterine fibroids: 12-month follow-up results

目的：比较肌壁间、粘膜下和浆膜下子宫肌瘤超声消融治疗的效果及差异。方法前瞻性研究应用超声消融治疗症状性子宫肌瘤的疗效，用MRI评估肌瘤体积消融率及治疗后6、12个月的体积变化，使用症状严重程度评分表（SSS）评估患者临床症状变化情况。结果2011年8月-2012年12月单中心110例患者145个肌瘤纳入本研究，其中肌壁间肌瘤72（49.7%），粘膜下肌瘤49（33.8%），浆膜下肌瘤24（16.6%）。治疗后体积消融率分别为（93.2±13.1）%、（94.9±9.3）%和（89.6±19.3）%，不同类型肌瘤体积消融率无统计学差异（P〉0.05）。治疗后6个月、12个月体积分别缩小（47.3±20.8）%、（70.3±22.2）%、（47.8±13.6）%和（58.9±19.9）%、（82.0±21.2）%、（50.5±17.8）%，粘膜下肌瘤体积缩小率大于肌壁间与浆膜下肌瘤（P〈0.05）。临床症状分别以肌壁间、粘膜下和浆膜下肌瘤为主的患者治疗前SSS评分分别为（29.1±15.2）、（34.8±14.5）、（26.6±23.4），治疗后6个月和12个月SSS评分分别为（18.4±15.8）、（15.5±10.7）、（11.6±11.7）和（18.9±13.2）、（16.8±14.0）、（11.5±9.1），与治疗前相比差异均有统计学意义（P〈0.05）。所有患者均无严重并发症发生。结论超声消融治疗肌壁间、粘膜下和浆膜下肌瘤均获得了较高的体积消融率，术后6、12个月随访肌瘤体积缩小和临床症状改善显著，可以为有保留子宫意愿的肌瘤患者提供一种新的治疗选择。

Objective To evaluate the effect of ultrasound-guided focused ultrasound ablation （US-FUA） in the treatment of intramural, submucosal and subserosal uterine fibroids. Methods We prospectively assessed the efficacy of US-FUA for treatment of symptomatic uterine fibroids by determining the volume ablation ratio immediately after the treatment and evaluating the volume changes of the uterine fibroids on contrast-enhanced MRI at 6 and 12 months after the treatment. The symptom severity score （SSS） was examined before and at 6 and 12 months after the treatment. Results A total of 110 women with 145 symptomatic fibroids undergoing US-FUA between August 2011 and December 2012 were enrolled. The fibroids were located intramurally in 72 （49.7%）, submucosally in 49 （33.8%） and subserosally in 24 （16.6%） patients, who had comparable mean volume ablation ratios [（93.2 ± 13.1）% vs （94.9 ± 9.3）% vs （89.6 ± 19.3）%, P〉0.05]. The volume of the treated fibroids was reduced by （47.3± 20.8）%, （70.3 ± 22.2）%and （47.8 ± 13.6）%at 6 months after US-FUA and by （58.9 ± 19.9）%, （82.0 ± 21.2）%, and （50.5±17.8）%at 12 months, respectively, demonstrating a more obvious volume reduction for submucosal fibroids （P〈0.05）. The SSS scores of the 3 groups before treatment were 29.1±15.2, 34.8±14.5 and 26.6±23.4, respectively, which decreased significantly to 18.4 ± 15.8, 15.5 ± 10.7, and 11.6 ± 11.7 at 6 months （P〈0.05） and to 18.9 ± 13.2, 16.8 ± 14.0, 11.5 ± 9.1 at 12 months （P〈0.05）. No major complications occurred in these patients during the 12-month follow-up. Conclusions US-FUA can yield high ablation ratios for intramural, submucosal and subserosal fibroids and result in significant volume reduction and symptomatic improvement at 6 and 12 months after the treatment, suggesting its value as a new noninvasive option for fibroid treatment in patients who wish to preserve the uterus.