高强度聚焦超声治疗不同类型子宫肌瘤的有效性和安全性

Efficacy and safety of high intensity focused ultrasound ablation for different types of uterine fibroids

目的分析高强度聚焦超声(HIFU)技术治疗子宫肌瘤的有效性和安全性,为临床提供依据。方法回顾性分析2006年10月~2009年11月重庆几家医院收治的113例(121个肌瘤)经HIFU治疗的子宫肌瘤患者的病历资料,所有患者均采用高强度聚焦超声治疗,随访6个月,并行增强MRI检查,分析治疗前后子宫肌瘤患者肌瘤体积变化情况、症状改善情况及不良反应发生情况。结果治疗后,113例子宫肌瘤患者的肌瘤体积显著小于治疗前(P<0.05);121个肌瘤中,83个肌瘤体积缩小≥50%,占68.60%;55个肌瘤体积缩小≥70%,占45.45%;治疗后,前壁、侧壁、后壁、宫底靶肌瘤体积均小于治疗前(P<0.05);治疗后,肌壁间肌瘤、浆膜下肌瘤、黏膜下肌瘤体积均小于治疗前(P<0.05);但不同位置和不同类型的肌瘤缩小率比较,差异无统计学意义(P>0.05);治疗后,113例患者经量增多、痛经、经期延长、尿路症状总缓解率分别为88.89%、86.36%、75.00%、91.67%;A级不良反应发生率为51.21%,均未予特殊处理,1周后自行缓解,B级不良反应发生率为6.19%,经处理后得以缓解,未出现严重不良反应。结论高强度聚焦超声技术治疗子宫肌瘤疗效显著,可有效缩小肌瘤体积,改善临床症状,不良反应发生较少,安全性较高,未来将在疾病的治疗中发挥更重要的作用,值得推广应用。

Objective To analyze the efficacy and safety of high intensity focus ed ultrasound ablation(HIFU)for different types of uterine fibroids,and provide a basis for clinical.Methods The clinical data in 113 pa tients(121 uterine fibroids)with HIFU treatment in our hospital rom October 2006 to November 2009 were retrospectively analyzed.All patients were treated with high intensity focused ultrasound ablation and followed up for 6 months,and enhanced MRI examination.The changes of myoma volume,symptom improvement and adverse reactions in patients with uterine fibroids before and after treatment were analyzed.Results After treatment,the myoma volume of 113 patients with uterine fibroids was significantly lower than before treatment(P<0.05);Among 121 myoma,the volume reduction of 83 myomas was more than 50%,accounting for 68.60%,the volume reduction of 55 myomas was more than 70%,accounting for 45.45%;After treatment,the volume of target myoma in anterior wall,lateral wall,posterior wall and fundus was smaller than that before treatment(P<0.05);After treatment,the volumes of intramural myoma,subserosal myoma and submucosal myoma were smaller than those before treatment(P<0.05);However,there was no significant difference in the reduction rate of myoma in different locations and types(P>0.05);After treatment,the total remission rates of 13 patients increased menstrual volume,dysmenorrhea,prolonged menstruation and urinary tract symptoms were 88.89%,86.36%,75.00%and 91.67%respectively;The incidence of grade A adverse reaction was 51.21%,which was not given special treatment and relieved after one week.The incidence of grade B adverse reaction was 6.19%,which was relieved after treatment and no serious adverse reaction occurred.Conclusion High intensity focused ultrasound ablation is effective in the treatment of uterine fibroids,it can effectively reduce the volume of myoma and improve the clinical symptoms,reduce adverse reactions,and higher safety.It will play a more important role in the treatment of diseases in the future,and is worthy of popularization and application.