六氟化硫微泡在高强度聚焦超声治疗子宫肌瘤中的临床价值

The clinical application of sulfur hexafluoride micro-bubbles in treating uterine fibroid with high intensity focused ultrasound

目的探讨六氟化硫微泡在高强度聚焦超声(HIFU)治疗子宫肌瘤中的临床应用价值。方法 2011年8月至2013年8月入院诊断为子宫肌瘤患者随机分成造影组(n=30)与非造影组(n=30),造影组HIFU治疗术前、中、后用六氟化硫微泡造影,非造影组术后造影。记录手术时间、出现块状灰度变化时间、辐照时间、肿瘤消融率、治疗剂量(J),两组参数用两独立样本t检验。结果造影组手术时间、出现块状灰度变化时间、辐照时间、治疗剂量分别为(71.71±53.22)min,(528.74±379.14)s,(827.97±696.43)s,(295 581.81±207 182.29)J,非造影组分别为(148.14±65.12)min,(1 171.42±877.42)s,(1 770.43±1 357.62)s,(597 705.71±464 389.85)J,两组各参数相比差异有统计学意义(P<0.05)。肌瘤消融率造影组为(78.42±5.77)%,非造影组为(76.10±10.11)%,两组各参数相比差异无统计学意义(P>0.05)。造影组患者未发生治疗区皮肤烧伤、下肢麻木,1例出现全身酸麻,并发症的发生率为1/30(3.3%)。非造影组治疗区皮肤Ⅱ度烧伤1例,下肢麻木1例,全身酸麻2例,并发症的发生率为4/30(13.3%),高于前者(P<0.001),差异有统计学意义。结论六氟化硫微泡在HIFU热消融子宫肌瘤中,可缩短手术时间,提高肿瘤消融率,减少并发症,具有明显的增效作用,在临床中发挥着重要的指导意义。

Objective To evaluate the clinical application of sulfur hexafluoride micro-bubbles, used as an ultrasound contrast agent, in treating uterine fibroid with high intensity focused ultrasound （HIFU）. Methods A total of 60 patients with uterine fibroid, who were admitted to authors＇ hospital during the period from August 2011 to August 2013, were randomly divided into the study group （using contrast agent, n=30） and the control group （not using contrast agent, n=30）. In the study group, contrast-enhanced ultrasonography with sulfur hexafluoride micro-bubbles was employed before, during and after HIFU treatment, while in the control group contrast-enhanced uhrasonography with sulfur hexafluoride microbubbles was performed only after HIFU treatment. The time of operation （rain）, the time of appearing block gray change （s）, irradiation time （s）, tumor ablation rate （%） and the therapeutic dose （J） were recorded, and the results were statistically analyzed by using two independent samples t-test. Results The time of operation, the time of appearing block gray change, the irradiation time and the therapeutic dose in the study group were （71.71±53.22） min, （528.74±379.14） s, （827.97±696.43） s and （295 581.81±207 182.29） J respectively, which in the control group were （148.14±65.12） min, （1 171.42±877.42） s, （1 770.43±1 357.62） s and （597 705.71±464 389.85 ） J respectively. The differences in the above mentioned 4 parameters between the two groups were statistically significant （P〈0.05）. The tumor ablation rates of the study group and the control group were （ 78.4±5.8 ） % and （ 76.1 ± 10.1 ） % respectively, the difference was not statistically significant （P〉0.05）. In the study group, no skin burns of treatment area or numbness of the lower limbs was observed, only one patient developed general muscular stiffness, the incidence rate of complication was 3.3% （1/30）. In the control group, Ⅱ degree skin burn of treatment area was seen in one patient, numbness of the lower limbs in one patient and general muscular stiffness in 2 patients, the incidence rate of complication was 13.3% （4/30）, which was statistically higher than that in the study group （P〈0.001）. Conclusion In performing HIFU thermal ablation treatment for uterine fibroid, the use of sulfur hexafluoride micro-bubbles can effectively shorten operation time, improve tumor ablation rate and reduce complications, it has obvious synergism for HIFU treatment and plays an important guiding significance in clinical practice.