高强度聚焦超声治疗子宫腺肌瘤的临床疗效观察

Clinical observation of high intensity focused ultrasound in the treatment of uterine fibroids

目的探讨高强度聚焦超声(HIFU)治疗子宫腺肌瘤的临床疗效。方法选取沧州市人民医院妇科HIFU治疗中心2015~2017年间因子宫腺肌瘤行HIFU治疗的110例患者作为研究对象,回顾分析所有患者的临床及随访资料,分析并比较所有患者治疗前后一般临床症状改善情况、瘤体大小、血流变化及超声影像学改变情况、痛经情况和月经量,记录患者治疗后的临床总有效率及治疗过程中的不良反应发生情况,并分析影响患者临床疗效的相关因素。结果 (1)经HIFU治疗后所有患者临床症状较治疗前明显改善,且改善率随着时间的延长逐渐提高(P<0.05)。(2)治疗后患者瘤体平均体积明显缩小,瘤体内血流信号逐渐减弱,经期间疼痛评分明显降低,月经量明显减少,与治疗前比较,差异均有统计学意义(P<0.05)。(3)经HIFU治疗后患者的临床总有效100例(90.91%),随时间的延长逐渐上升(P<0.05)。(4)至随访结束,不同病灶消融率及不同程度灰度患者间临床总有效率均不同,病灶消融率较大及整体灰度者临床总有效率较病灶消融率较低和团块灰度者好(P<0.05)。(5)非条件多因素logistic回归分析显示,病灶消融率(<80%)和消融后瘤体灰度(团块)是影响经高强度聚焦超声治疗的子宫腺肌瘤患者临床疗效的独立危险因素(P<0.05)。(6)总治疗开始至随访结束时患者出现不良反应12例(10.91%),所有不良反应予相应处理后均消失,未对患者造成影响,且无明显严重不良反应的发生。结论 HIFU可明显改善子宫腺肌瘤患者的临床症状,临床疗效尚可,且治疗过程中无明显严重不良反应发生,但消融后瘤体灰度的大小是影响临床疗效的独立危险因素,因此应加大病灶消融率以进一步提高临床有效率。

Objective To investigate the clinical efficacy of high intensity focused ultrasound（HIFU）in the treatment of adenomyosis.Methods 110 patients with uterine adenomyosis treated with HIFU were selected as the subjects admitted to Cangzhou People＇s Hospital gynecology HIFU treatment center from 2015 to 2017.The clinical and follow-up data of all patients were retrospectively analyzed.The general clinical symptoms,the size of the tumor,the changes of blood flow and ultrasound imaging,the condition of dysmenorrhea and menstruation in all patients were analyzed and compared before and after the treatment.The clinical total effective rate and the incidence of adverse reactions during the treatment were recorded.Results After HIFU treatment,the clinical symptoms of all patients were significantly improved than that before,and the improvement rate gradually increased with time（P〈0.05）.The average volume of tumor was significantly reduced after treatment.Intratumoral blood flow signal gradually weakened.Menstrual pain score decreased significantly,menstrual volume were significantly reduce,which were statistically significant compared with before treatment.The clinical efficacy of this group of patients after HIFU treatment was acceptable,and with the time the clinical total effective rate was gradually increased（P 0.05）.The clinical total effective cases was 100 from the treatment to the end of follow-up from the beginning of treatment to the end of follow-up（90.91%）.The total effective rate of treatment group was significantly higher than that of the control group 12 cases（10.91%）.All the adverse reactions to the corresponding treatment disappeared.There were no impact on patients,and no obvious serious adverse reactions.Conclusion HIFU can significantly improve the clinical symptoms of patients with adenomyosis,which has a good clinical efficacy.No serious adverse reaction is detected in the course of treatment,which could be used as a safe and effective treatment for clinical adenomyoma.