超声引导下微波消融子宫肌瘤临床应用研究

Clinical application of ultrasound-guided microwave ablation for uterine fibroids

目的:研究超声引导下微波消融子宫肌瘤大小与消融所需能量的关系,评估微波消融子宫肌瘤疗效。方法:选取行超声引导下经皮穿刺微波消融治疗的18例子宫肌瘤患者(27枚肌瘤),年龄33～49岁,平均年龄(41.7±5.3)岁;按照子宫肌瘤均径将其分为≤5 cm组和>5 cm组,≤5 cm组共10枚肌瘤,>5 cm组共17枚肌瘤。固定微波功率(50 W,300 s)消融每枚子宫肌瘤,超声造影观察比较两组肌瘤消融范围,随访观察子宫肌瘤患者症状缓解情况。结果:子宫肌瘤均径≤5 cm组,微波消融均径约(3.40±0.84)cm;子宫肌瘤均径>5 cm组,微波消融均径约(4.01±0.77)cm,定量消融范围大于均径≤5 cm肌瘤,两者比较差异有统计学意义(t=2.13,P<0.05)。微波消融治疗后随访3～12个月,11例患者月经量过多症状得到改善,贫血改善4例,尿频改善6例,下腹痛明显好转6例。结论:消融单位体积小肌瘤(均径≤5 cm)微波消融所需能量大于大肌瘤(均径>5 cm),超声引导下微波消融子宫肌瘤可有效缓解子宫肌瘤患者临床症状。

Objective To study the relationship between uterine fibroid size and needed energy of ultrasound-guided microwave ablation, and to evaluate the efficacy of microwave ablation for uterine fibroids. Methods： Eighteen patients with uterine fibroids （27 fibroids） who underwent percutaneous punctured microwave ablation under ultrasound guidance （aged： from 33 to 49 years old, mean value： 41.7±5.3 years old） were selected. According to the average diameter of uterine fibroids, they were divided into the ≤5 cm group （10 fibroids） and the 〉5 cm group （17 fibroids）. The fixed microwave power （50 W, 300 s） was used to ablate each uterine fibroid, and the range of fibroid ablation between the two groups was compared by contrast-enhanced ultrasound. The situation of symptom remission of patients with uterine fibroids were observed in further followed up. Results： In ≤5 cm group, the average diameter post microwave ablation was about （3.40±0.84） cm. In 〉5 cm group, the average diameter post microwave ablation was about （4.01±0.77） cm which was significantly larger than that of ≤5 cm group（t=2.13, P〈0.05）. In the follow-up of 3-12 mo post microwave ablation, 11 cases with hypermenorrhea symptom, 4 cases with anemia, 6 cases with frequent micturition and 6 cases with hypogastralgia were obviously improved. Conclusion： the energy required for microwave ablation of small fibroids per unit volume （average diameter ≤5 cm） is greater than that of large fibroids （average diameter 〉5 cm）, Ultrasound-guided microwave ablation of uterine fibroids can effectively relieve the clinical symptoms of patients with uterine fibroids.