动态血管模型在六氟化硫微泡联合高强度聚焦超声消融富血供子宫肌瘤中的增效作用

The synergistic effect of dynamic vascular model in sulfur hexafluoride microbubbles combined with HIFU ablation for fibroids with rich blood supply

目的探讨动态血管模型(dynamic vascular pattern,DVP)在六氟化硫微泡(声诺维)联合高强度聚焦超声(HIFU)消融富血供肌瘤中的增效作用及安全性。方法回顾性分析2014年7月至2018年6月行单纯HIFU治疗36例(HIFU组),非DVP增效组32例(非DVP组)和DVP组28例患者的临床资料,比较3组患者的超声辐照时间、手术时间、超声灰度变化时间、消融率、能效因子(EEF)、治疗效率、治疗剂量、无灌注区体积(NPV)等治疗参数。比较患者治疗6个月时的子宫肌瘤体积缩小率、症状评分、生活质量评分、月经评分。根据SIR分类,统计3组患者HIFU治疗后的不良事件。结果3组间消融率、EEF、治疗效率、治疗剂量、NPV等治疗参数比较差异具有统计学意义(P<0.05)。治疗后6个月比较3组间的症状评分、生活质量评分、月经评分,差异有统计学差异(P<0.05)。不良事件发生率3组间比较差异无统计学意义(P>0.05)。结论DVP可提高声诺维在HIFU治疗富血供肌瘤中的增效作用,是一种安全有前景的增效方法。

Objective To investigate the synergistic effect and safety of dynamic vascular pattern(DVP)in sulfur hexafluoride microbubbles(SonoVue)combined with high intensity focused ultrasound(HIFU)ablation for fibroids with rich blood supply.Methods The clinical data of 36 fibroids patients receiving simple HIFU ablation(HIFU group),32 fibroids patients receiving non-DVP synergist treatment(non-DVP group)and 28 fibroids patients receiving DVP synergist treatment(DVP group),who were admitted to authors’hospital to receive treatment during the period from July 2014 to June 2018,were retrospectively analyzed.The ultrasound irradiation time,operation time,ultrasound grayscale change time,ablation rate,energy efficiency factor(EEF),treatment efficiency,therapeutic dose,no perfusion area volume(NPV)and other treatment parameters were compared between each other among the three groups.The patient’s fibroids volume reduction rate,symptom score,quality of life score,and menstrual score at 6 month after treatment were also compared between each other among the three groups.According to SIR classification,the adverse events after HIFU treatment in the three groups were calculated.Results Statistically significant differences in the ablation rate,EEF,treatment efficiency,therapeutic dose,NPV and other treatment parameters were existed between each other among the three groups(P<0.05).Sixth months after treatment,the symptom scores,quality of life scores,menstrual scores were compared between each other among the three groups,and the differences were statistically significant(P<0.05).No significant difference in the incidence of adverse events existed between each other among the three groups(P>0.05).Conclusion The use of DVP can improve the synergistic effect of SonoVue in HIFU treatment for fibroids with rich blood supply,and it is a safe and promising synergistic method.