超声造影评价高强度聚焦超声消融治疗子宫肌瘤疗效的价值

Evaluation of high intensity focused ultrasound therapeutic effect on uterine fibroid by contrast-enhanced ultrasound

目的:比较超声造影与常规彩色多普勒超声观察子宫肌瘤高强度聚焦超声(high intensity focused ultrasound,HIFU)消融治疗后效果,探讨超声造影评估HIFU治疗子宫肌瘤疗效的临床价值。方法:98例子宫肌瘤患者共113个肌瘤(最大径1.9~7.8 cm),随机分为实验组(n=52)及对照组(n=46)。实验组采用超声造影观察HIFU消融前后肌瘤情况,以肿瘤内仍有强化区域判断为残留病灶再次消融,对照组则采用常规彩超观察,以肿瘤内低回声区域仍有彩色血流信号区域判断残留病灶再次消融。于治疗后第6个月复查,比较两组的消融效果。结果:两组患者HIFU治疗后多数肌瘤体积均可见缩小,实验组治疗6个月后肌瘤体积缩小率明显高于对照组(P<0.05),实验组治疗的显著有效率为91.9%,明显高于对照组的64.7%(P<0.05)。结论:超声造影技术能更准确地评价治疗前后肌瘤的范围及血流灌注情况,比常规彩超能更及时反映消融效果,引导残余病灶再次消融,可为HIFU治疗子宫肌瘤的疗效早期评估提供一种无创简便且更有效的新方法。

Objective:To assess the utility of contrast-enhanced ultrasonography (CEUS) in the assessment of the therapeutic response to high intensity focused ultrasound (HIFU) ablation in patients with uterine fibroid by comparison with color Doppler ultrasound(CDFI).Methods:98 patients with uterine leiomyoma were randomly divided into experimental group ( n =52) and control group ( n =46) with 113 leiomyomas (range:1.9-7.8 cm).In experimental group (CEUS group),residual unablated lesion was judged by hyper-enhancement of the lesion and additional HIFU ablation performed.In control group (CDFI group),residual lesion was judged by hypo-echo and color Doppler flow and additional HIFU ablation followed.All the patients were followed up 6 months after HIFU ablation and the results between the two groups were compared.Results:The volumes of most uterine fibroids decreased in different degrees 6 months after HIFU ablation in both groups while the volume decrease rate was much higher in experimental group than that in control group( P <0.05).The markedly effective rate of HIFU ablation was much higher in experimental group(91.9%) than that in control group (64.7%, P <0.05).Conclusion:Contrast-enhanced ultrasonography is more accurate in assessment of the range and perfusion of uterine fibroid than color Doppler ultrasound,and more timely manifest the therapeutic results of HIFU,therefore guide additional ablation of residual lesion.CEUS is potentially useful for evaluating the early therapeutic effect of HIFU ablation for uterine fibroids.