高强度聚焦超声治疗子宫肌瘤2年随访结果分析

High intensity focused ultrasound surgery for uterine fibroids:evaluation of two-year outcome

目的探讨超声引导下高强度聚焦超声(HIFU)治疗子宫肌瘤的安全性及有效性。方法回顾性研究2010年12月至2014年6月在遂宁市中心医院经HIFU治疗且要求完成2年随访的患者450例、655个肌瘤,分析随访情况,评价治疗参数、非灌注体积率(NPVR)、不良反应及并发症发生情况。结果 (1)治疗参数:治疗时间74(47~119)min;辐照时间652(399~1128)s;治疗强度557(454~652)s/h。400例患者、580个肌瘤消融治疗后即刻超声造影显示消融率(NPVR)83%(65%~100%)。其中,肌瘤消融率大于80%者325个,占56%,消融率大于90%者230个,占40%,实现完全消融者(消融率100%)146例,占25%。另有50例(75个肌瘤)患者存在超声造影禁忌,治疗后未行即刻超声造影。(2)不良反应:主要出现的不良反应有下腹部治疗区域疼痛(100/450)、骶尾部疼痛(45/450)、下肢感觉运动功能异常(3/450)、阴道少量流血(4/450)、阴道少量排液(16/450)、术区皮肤损伤(2/450)、恶心、胃部不适(6/450)、肛门坠胀(1/450)、发热(1/450)、尿潴留(1/450)、黏膜下肌瘤排出不畅并发感染(1/450)。所有治疗患者均无远期及严重并发症发生。(3)治疗前后肌瘤及子宫体积变化:术前、术后6个月、1年、2年子宫肌瘤体积分别为15.5(4.7~52.3)cm^3、6.8(2.3~21.7)cm^3、4.7(1.5~17.1)cm^3、3.6(0.7~13.5)cm^3;子宫体积分别为165.8(122.5~226.2)cm^3、144.4(108.0~191.2)cm^3、137.7(104.9~179.1)cm^3、124.1(90.5~167.6)cm^3,术后肌瘤及子宫体积均呈缩小趋势,差异均有统计学意义(P<0.01)。(4)子宫肌瘤症状与生活质量问卷(UFS-QOL)的变化:术前、术后6个月、1年、2年的症状严重性评分(SSS)分别为13(6~22)分、3(0~7.5)分、0(0~3)分、0(0~3)分,术后较术前显著降低,差异有统计学意义(P<0.01)。术前、术后6个月、1年、2年的生存质量评分(HRQL)评分分别为77(69~81)分、87(80~91)分、91(85~95)分、93(86~97)分,术后较术前明显提高,差异有统计学意义(P<0.01)。(5)治疗后再手术率:12个月内选择手术治疗的患者共6例,24个月内选择手术治疗的患者共13例(包括肌瘤剔除或子宫切除),2例二次HIFU治疗。结论HIFU治疗子宫肌瘤较为安全,无严重不良反应及远期并发症发生,再干预率低。

Objective To evaluate the safety,efficacy of ultrasound-guided high-intensity focused ultrasound in the treatment of uterine fibroids.Methods A retrospective study was conducted in 450 patients with 655 fibroids treated with HIFU and required to complete 2-year follow-up in Suining Central Hospital from December 2010 to June 2014.The follow-up,the parameters of treatment,non-perfusion volume rate（NPVR）,adverse reactions and complications were analyzed.Results（1）Treatment data：the mean treatment time was 74（47-119）min,the mean irradiation time was 652（399-1128）s,and treatment intensity was 557（454-652）s/h. The 400 patients,580 fibroids ablation immediately after ultrasound imaging showed NPVR 83%（65%-100%）. Among them,more than 80% in 325 fibroids,accounting for 56%;greater than 90% in 230,accounting for 40%;NPVR was 100% in 146 fibroids,accounting for 25%.（2）Adverse events：adverse events included lower abdominal pain in treatment area（100/450）,sacrococcy geal pain（45/450）,lower extremity sensory motor function abnormalities（3/450）,vaginal bleeding（4/450）,vaginal discharge（a small amount of vaginal discharge）（16/450）,skin lesion（2/450）,nausea and stomach discomfort（6/450）,anal bulge（1/450）,fever（1/450）,urinary retention（1/450）,and submucosal fibroids discharged poorly with infection（1/450）;all patients had no long-term and serious complications.（3）Volume changes：the volume of leiomyoma before the treatment and 6,12 and 24 months after the treatment was 15.5（4.7-52.3）cm^3,6.8（2.3-21.7）cm^3,4.7（1.5-17.1）cm^3 and 3.6（0.7-13.5）cm^3,respectively,and the volume of uterine before the treatment and 6,12 and 24 months after the treatment was 165.8（122.5-226.2）cm^3,144.4（108.0-191.2）cm^3,137.7（104.9-179.1）cm^3 and 124.1（90.5-167.6）cm^3,respectively.Both leiomyoma and uterine volumes decreased significantly after treatments（P〈0.01）.（4）UFS-QOL change：the symptom severity score（SSS）before the treatment and 6,12 and 24 months after the treatment was 13（6-22）,3（0-7.5）,0（0-3）,0（0-3）,which decreased significantly（P〈0.01）. The health-related quality of life（HRQL）before the treatment and 6,12 and 24 months after the treatment was 77（69-81）,87（80-91）,91（85-95）,93（86-97）,which increased dramatically（P〈0.01）.（5）The rate of secondary surgery：6 patients were treated by myoectomy and hysterectomy within 12 months of follow-up,13 patients chose surgical treatment during the 24-month follow-up,and 2 patients selected secondary HIFU treatment.Conclusion HIFU treatment for some patients with uterine fibroids has good effect.