改良射频消融术治疗子宫肌瘤的临床应用和效果评价

Clinical application of improved radiofrequency ablation to treatment of uterine myomas

目的应用改良射频消融技术治疗子宫肌瘤，与常规射频消融术比较观察临床效果。方法142例子宫肌瘤患者共164枚肌瘤，瘤体直径2．0～6．3cm，用随机数字表法分为常规射频消融术治疗组（常规组）60例，改良射频消融术治疗组（改良组）82例，分别采用射频消融技术及在此基础上增加治疗时间、术后取瘤并局部降温的方法进行治疗。采用三维彩超测量术前及术后1、3、6个月时子宫及肌瘤体积，比较两组患者的子宫及肌瘤缩小率，观察临床治愈率、总有效率和术后并发症发生率。结果常规组、改良组射频消融后1个月子宫缩小率分别为9．54％和10．14％，肌瘤缩小率分别为32．56％和36．59％，差异均无统计学意义（P〉0．05）。术后3个月及6个月时两组患者的子宫缩小率分别为32．52％、44．81％和42．51％、60．73％，肌瘤缩小率分别为48．28％、54．44％和61．30％、68．43％，差异均有统计学意义（P〈0．05）。术后6个月时常规组、改良组患者的治愈率分别为63．33％（38／60）和78．05％（64／82），差异有统计学意义（P〈0．05），总有效率分别为95．00％（57／60）和98．78％（81／82），差异无统计学意义（P〉0．05）。术后常见并发症包括下腹疼痛、阴道流血、阴道排液、发热。改良组的并发症发生率为10．98％（9／82），低于常规组的23．33％（14／60），差异有统计学意义（P〈0．05）。结论改良射频消融术治疗子宫肌瘤后明显缩小子宫和肌瘤体积，临床效果显著，术后并发症少，可以作为微创治疗子宫肌瘤的主要方法。

Objective To assess the clinical effects of improved and conventional radiofrequency ablation （RFA） on uterine myomas （UM）. Methods A total of 142 patients with UM （ 164 myomas with diameter of 2.0 - 6.3 cm） were divided into conventional RFA group （ n = 60） and improved RFA group （ n = 82）. treatment time and combined postoperative enucleation plus local Additionally, the improved RFA group was treated with extended cooling. Three-dimensional color Doppler ultrasound was used to measure uterine size and UM volume before operation and at 1,3 and 6 months after operation. The reduced rate of uterine and UM were compared between the two groups. Clinical cure rate, effective rate and the incidence of complications were evaluated. Results After one month＇ s treatment, the reduced rate of uterine size of conventional RFA vs improved RFA was 9.54% vs 10.14% , the reduced rate of UM volume was 32.56% vs 36.59%. There were no significant differences in the decreased rates of uterine size and UM volume between the two groups （P 〉 0.05 ）. After three and six month＇ s treatment, the outcomes were 32.52% vs 42.51% and 44.81% vs 60.73% for reduced rate of uterine size and 48.28% vs 61.30% and 54.44% vs 68.43% for reduced rate of UM volume （ P 〈 0.05 ）. After six months＇ treatment, the cure rates of the two groups were 63.33% （38/60） and 78.05% （64/82） , and the effective rate were 95.00% （57/60） and 98.78% （81/82） , respectively. There was a significant difference in cure rate between the two groups （ P 〈 0. 05 ） and effective rate was of no significant differences （ P 〉 0.05 ）. The common complications after operation were lower abdominal pain, vaginal bleeding, vaginal drainage and fever. The incidences of complications after conventional and improved RFA treatment were respectively 23.33% （14/60） and 10.98% （9/82）, between which there was a significant difference （P 〈 0. 05）. Conclusion Improved RFA treatment can significantly reduce uterine size and UM volume. Its clinical curative effect is distinct with rare complications. As a minimally invasive treatment, it is a primarily clinical approach to uterine myomas.