经皮无水乙醇+碘油注射联合超声消融治疗子宫肌瘤

Percutaneous ethanol + lipiodol injection combined with high intensity focused ultrasound in treatment of uterine fibroids

目的评价经皮无水乙醇(PEI)+碘油注射联合HIFU治疗"HIFU-难治型"子宫肌瘤的有效性及安全性。方法将75例单发子宫肌瘤患者按照治疗时间顺序分为研究组和对照组,研究组采用PEI+碘油联合HIFU治疗,对照组采用HIFU治疗,将两组分为T2WI高信号亚组、后壁亚组、T2WI高信号亚组+后壁亚组,分析"HIFU-难治型"肌瘤的疗效及安全性。结果研究组及对照组消融率、肌瘤1个月体积缩小率和单位体积治疗时间差异均有统计学意义(P均<0.05)。研究组及对照组T2WI高信号亚组消融率、单位体积治疗时间差异均有统计学意义(P均<0.05)。研究组及对照组后壁亚组消融率、肌瘤1个月体积缩小率差异有统计学意义(P<0.05)。研究组及对照组T2WI高信号+后壁亚组消融率、肌瘤1个月体积缩小率、单位体积治疗时间差异均有统计学意义(P<0.05)。研究组与对照组总体并发症发生率分别为84.21%(32/38)、70.27%(26/37;P>0.05),研究组及对照组T2WI高信号+后壁亚组并发症发生率为100%(14/14)、66.67%(6/9,P<0.05),但均为轻度。结论 PEI可提高HIFU治疗子宫肌瘤的疗效,可作为治疗"HIFU-难治型"子宫肌瘤的一种辅助手段,但需注意并发症的防控。

Objective To evaluate the efficacy and safety of percutaneous ethanol injection（ PEI） ＋ lipiodol combined with HIFU in treatment of HIFU-refractory uterine fibroids. Methods Totally 75 uterine fibroids patients were divided into study group and control group,the study group treated with PEI ＋ lipiodol combined with HIFU,the control group treated with HIFU; the T2 WI high signal subgroup,posterior subgroup,T2 WI high signal ＋ posterior wall subgroup were divided in both groups respectively. The efficacy and safety were compared. Results The ablation rate,fibroid volume reduction ratio and the unit volume treatment time in both groups had significant statistical differences（ all P〈0. 05）. In T2 WI high signal subgroups of study group and control group,ablation rate and the unit volume treatment time had statistical differences（ all P〈0. 05）. In posterior wall subgroups of study group and control group,the ablation rate,tumor volume reduction rates in 1 month were found significant difference（ P〈0. 05）. In T2 WI high signal ＋ posterior wall subgroups of both groups,the ablation rate,tumor volume reduction rates in 1 month,and the unit volume treatment time had significant differences（ all P〈0. 05）. The overall complication rate of study group and the control group was 84. 21%（ 32 /38）,70. 27%（ 26 /37,P〈0. 05） respectively; in T2 WI high signal ＋ posterior wall subgroup of both groups,the complication rate were 100%（ 14 /14）,66. 67%（ 6 /9,P〈0. 05）,which were mild degrees.Conclusion PEI is a safe adjuvant treatment that can improve the efficacy of HIFU for refractory uterine fibroids. But it need pay attention to control the incidence of complications.