子宫肌瘤血流情况和回声水平在超声引导下射频消融子宫肌瘤中的应用价值

The value of uterine fibroids blood flow and echo level in the radiofrequency ablation treatment of uterine fibroids

目的观察超声引导下经阴道子宫肌瘤射频消融中子宫肌瘤的血流情况及回声水平对消融时间、消融针数的影响。方法将48例行射频消融的子宫肌瘤患者根据三维血管能量成像检测血流情况分为乏血供组和富血供组,再根据回声水平各组内又分为高回声、低回声及混合回声,比较两组间及两组内不同回声消融时间、消融针数。结果乏血供组和富血供组中,高回声子宫肌瘤平均消融时间和消融针数分别为(14.98±0.89)min、(1.40±0.55)针和(17.58±0.65)min、(2.60±0.55)针,明显低于低回声子宫肌瘤[(25.09±0.72)min、(5.36±0.81)针和(27.21±0.86)min、(6.64±0.51)针],混合回声处于两者之间;不同回声子宫肌瘤消融时间及消融针数比较差异均有统计学意义(均P<0.05)。同一回声水平中,乏血供组消融时间和消融针数明显低于富血供组,差异均有统计学意义(均P<0.05)。结论超声引导下射频消融子宫肌瘤中,富血供低回声子宫肌瘤较乏血供高回声子宫肌瘤消融时间相对长,消融针数相对多。子宫肌瘤的血流情况及回声水平可指导操作者在射频消融时,对不同类型的子宫肌瘤进行有针对性的布针消融,可预计消融时间和消融针数,避免消融不彻底或消融过度。

Objective To observe the effects on ablation time and numbers of needle of uterine fibroids blood flow and echo level in the radiofrequency ablation（RFA）treatment guiding by ultrasound. Methods The 48 patients with uterine fibroids treated by RFA were divided into hypovascular and hypervascular groups according to 3D color power angiography,then divided was into hyperechoic,hypoechoic and mixed groups according to echo level. Recording the ablation time and numbers of needle of each group,then the differences in the whole treatment were investigated. Results In the hypovascular and hypervascular groups,the mean ablation time and numbers of needle of hynerechoic subgroups were（14.98±0.89）min and（1.40±0.55）needles,（17.58±0.65）min and（2.60±0.55）needles respectively,which were significantly lower than those of hypoechoic subgroups.The mean ablation time and numbers of needle of hypoechoic subgroups were（25.09 ±0.72）min and（5.36 ±0.81）needles,（27.21±0.86）min and（6.64±0.51）needles repectively. The mean ablation time and numbers of mixed subgroups were between hyperechoic and hypoechoic groups. The differences were statistically significant（all P0.05）.At the same echo level,the mean ablation time and numbers of needle of hypovascular group were significantly lower than those of hypervascular groups,the differences were statistically significant（all P0.05）. Conclusion Compared with hypovascular and hyperechoic uterine fibroids in RFA treatment,the ablation time of hypervascular is longer and more numbers of needle are needed. This would guide the operator to arrange the needles in RFA treatment according to different types of uterine fibroids,and the precise ablation time and numbers of needle to avoid insufficient or excessive ablation.