高强度聚焦超声消融治疗子宫肌瘤疗效观察

Effect of high intensity focused ultrasound ablation therapy on uterine myoma

目的观察高强度聚焦超声(high intensity focused ultrasound,HIFU)消融治疗子宫肌瘤的疗效。方法应用HIFU消融技术治疗74例子宫肌瘤患者,术中应用造影剂显影随时观察治疗效果,治疗后连续1周电话询问患者有无不适反应,随访治疗后1、3、6、12个月临床症状的改善情况,以及3、6、12个月复查B超,与治疗前对比评价治疗效果。结果临床表现为月经过多、尿频、便秘、贫血的患者治疗后症状明显好转,治疗前共76例次,治疗后1、3、6、12个月分别好转51、63、72、75例次,好转率依次为67.1%、82.9%、94.7%、98.7%;治疗后3、6、12个月子宫肌瘤体积逐渐缩小,中位数(四分位数间距)分别为38.43(49.64)cm3、23.07(35.70)cm3、11.67(12.63)cm3,与治疗前比较,差异均有统计学意义(Z值分别为7.391、7.424、7.424,P<0.01),治疗后6个月、12个月与治疗后3个月比较,差异均有统计学意义(P<0.01);而治疗后6个月与12个月比较,变化不明显,差异无统计学意义。结论 HIFU消融技术可使肿瘤体积明显缩小,临床症状得到显著改善,是一种可保留子宫且安全、有效治疗子宫肌瘤的理想方法。

Objective To observe the clinical effect of treatment on uterine myoma in high intensity focused ultrasound abla-tion.Methods 74 patients with uterine myoma were treated by high intensity focused ultrasound ablation, treatment effect was ob-served using a contrast agent, asking discomfort of patients after treatment for 1 week in by phone, following-up, after a month, three months, six months, one-year, improvement of clinical symptoms, while re-examing by ultrasound B, comparatively evaluating treat-ment results.Results After treatment, clinical manifestations of menorrhagia, urinary frequency, constipation, anemia were im-proved.Among a total of 76 patients with these symptoms before treatment, one month, three months, six months, 12 months after treatment, 51 cases, 63 cases, 72 cases, 75 cases improved, with average improvement rates of 67.1%, 82.9%, 94.7%, 98.7%. After three months, six months, 12 months, uterine fibroid volume gradually reduced, medians were 38.43 （49.64）, 23.07 （35.70）, 11.67（12.63） cm3, respectively, compared with before treatment, the differences were statistically significant （Z values were 7.391, 7.424, 7.424, P〈0.01）; Comparing 6 months, 12 months with 3 months after treatment respectively, the difference was statistically significant（P〈0.01）.Comparing 12 months with six months, uterine fibroid volume little changed, the difference was not statistically significant.Conclusions High intensity focused ultrasound ablation technique can significantly reduce the tumor vol-ume, clinical symptoms improved significantly, it is a safe and effective ideal way to conserve uterus and cure uterine myoma.