高强度聚焦超声治疗巨大子宫肌瘤的安全性及有效性研究

Study on safety and efficacy of high intensity focused ultrasound in treatment of giant uterine fibroids

目的探讨高强度聚焦超声(HIFU)治疗巨大子宫肌瘤(GUR)的安全性及有效性,为临床合理治疗GUR提供依据。方法选取2011年6月至2015年5月在重庆医科大学附属第一医院海扶医院行HIFU治疗的GUR患者50例,治疗后第1天复查增强MRI测得并计算肌瘤消融率,治疗后6个月进行随访,比较治疗前、后瘤体大小的变化,随访临床症状改善情况;统计治疗后疼痛、下肢放射痛、阴道分泌物异常等不良反应情况,按国际介入放射治疗学会(SIR)标准评价治疗相关的不良反应;评估治疗的有效性及安全性。结果 50例患者共52个肌瘤均顺利接受HIFU消融治疗,治疗中均出现灰度改变,术后消融率为(77.8±14.9)%。治疗后6个月随访,肌瘤体积均小于治疗前,缩小率为(59.6±20.8)%,差异有统计学意义(P<0.05)。临床症状均有不同程度的改善。治疗后无严重并发症发生。结论 HIFU对GUR的治疗安全、有效,可以作为临床上GUR的治疗方案之一。

Objective To investigate the safety and effectiveness of high intensity focused ultrasound （HIFU） in the treatment of giant uterine fibroids（GUF） to provide evidence for its clinical rational treatment. Methods Totally 50 patients with GUF treated with HIFU in the Chongqing Haifu Hospital from June 2011 to May 2015 were selected. The enhanced MRI was reexamined on 1 d after treatment for measuring and calculating the fibroids ablation rate. Follow up was performed for 6 months after treatment. The change of tumor size was compared between before and after treatment, the improvement situation of clinical symptoms was followed up. The adverse reactions situation of pain after treatment, radiating pain of lower limbs and vaginal abnormal discharge was performed the statistics. The treatment related adverse reactions were evaluated according to the criteria of the International Society for Interventional Radiotherapy（SIR）. The effectiveness and safety of treatment were evaluated. Results Total 52 GUF in 50 cases were smoothly received the HIFU ablation therapy ,the grey scale change was observed during treatment, the postoperative ablation rate was（77.8±14.9）%. The tumor volume was smaller than before treatment by 6-month follow up with the shrinkage rate of（59.6 ±20.8）% ,and the difference was statistically significant （P〈0.05） ,the clinical symptoms were improved in different degrees. No serious complications occurred after treatment. Conclusion HIFU is safe and effective for the treatment of GUF and can be used as one of treatment schemes in clinic.