HIFU治疗超声衰减宽度<10mm声通道腹壁瘢痕子宫肌瘤患者的有效性及安全性

Efficacy and safety of HIFU ablation for uterine fibroids in patients with abdominal surgical scars in acoustic pathway causing acoustic attenuation width <10mm

目的探讨超声引导下HIFU治疗声通道腹壁瘢痕造成超声衰减宽度<10mm的子宫肌瘤患者的安全性及有效性。方法共纳入861例子宫肌瘤患者,于HIFU消融治疗前后行盆腔增强MR检查,其中202例腹壁瘢痕造成超声衰减宽度<10mm(瘢痕组),659例无瘢痕(无瘢痕组),比较2组消融治疗效果、术中不良反应及术后并发症情况。结果对所有患者均完成HIFU治疗,瘢痕组和无瘢痕组子宫肌瘤体积消融率分别为(80.31±18.16)%、(79.60±17.57)%(P=0.620)。瘢痕组术中皮肤烫发生率[52.97%(107/202)]较无瘢痕组[41.58%(274/659)]高(P=0.004),瘢痕组和无瘢痕组术后MRI示腹壁水肿发生率分别为19.80%(40/202)、14.87%(98/659;P=0.095)。结论超声衰减宽度<10mm的声通道腹壁瘢痕对HIFU治疗子宫肌瘤的有效性及安全性无明显影响。

Objective To evaluate the therapeutic efficacy and safety of HIFU ablation for uterine fibroids in patients with abdominal surgical scars in acoustic pathway causing acoustic attenuation width 〈10 mm. Methods Totally 861 patients with uterine fibroids were referred for HIFU treatment and underwent contrast-enhanced MR scans before and after HIFU ablation. Among all patients, 202 had abdominal surgical scars causing width 〈10 mm acoustic attenuation （abdominal scars group） and 659 had no abdominal surgical scars （without abdominal scars group）. The outcomes, intra-operative adverse reactions and post-operative complications between the two groups were compared. Results HIFU ablation was successfully performed in all patients. The volume ablation rate was （80.31±18.16）% in abdominal scars group and （79.60±17.57）% in without abdominal scars group （P=0.620）. The rate of ‘hot’ skin sensation during HIFU procedure in abdominal scars group （52.97%[107/202]） was higher than that in without abdominal scars group （41.58%[274/659]; P=0.004）. Anterior abdominal wall edema was found in 40 cases （40/202, 19.80%） in abdominal scars group and 98 cases （98/659, 14.87%） in without abdominal scars group on post-operation MRI （P=0.095）. Conclusion Prior abdominal surgical scars in acoustic pathway causing width 〈10 mm acoustic attenuation has not significantly influence on the efficacy and safety of HIFU treatment for uterine fibroid.