高强度聚焦超声对子宫肌瘤治疗效果的相关因素研究

Factors related to the efficacy of high-intensity focused ultrasound in the treatment of uterine fibroids

目的探究高强度聚焦超声对子宫肌瘤疗效的相关因素。方法选取2015年3月至2018年3月北部战区总医院治疗的388例子宫肌瘤患者作为研究对象。按照子宫肌瘤消融率将患者分为低消融率组(直径减少率<50%,77例)、中消融率组(直径减少率为50%~75%,132例)和高消融率组(直径减少率>75%,179例)。随访6个月,比较三组子宫肌瘤的直径、位置、MRI信号强弱,对有统计学意义的指标行多因素Logisitic回归分析,探究高强度聚焦超声治疗子宫肌瘤疗效影响因素。结果低消融率组子宫肌瘤直径以<30mm为主,肌瘤位置以后壁、侧壁和宫底为主;中消融率组子宫肌瘤直径以30~50mm为主,位置以前壁为主;高消融率组子宫肌瘤直径以>50mm为主,肌瘤位置以前壁为主;三组差异具有统计学意义(P<0.05);三组中T1WI增强强度和T2WI信号强度处于高等的比例呈现出低消融率组>中消融率组>高消融率组,三组分布比较,差异具有统计学意义(P<0.05);多因素Logisitic回归分析显示,子宫肌瘤直径>50mm、位置为前壁、T1WI增强强度低、T2WI信号强度低是子宫肌瘤女性高强度聚焦超声疗效高的影响因素。结论子宫肌瘤女性高强度聚焦超声疗效与子宫肌瘤直径、位置、T1WI增强程度和T2WI信号强度有关,临床上应该加以重视。

Objective To investigate the factors related to the efficacy of high-intensity focused ultrasound on uterine fibroids. Methods 388 patients with uterine fibroids treated in the North Theater General Hospital from March 2015 to March 2018 were selected as the research subjects. According to the ablation rate of uterine fibroids, the patients were divided into low ablation rate group(diameter reduction rate < 50%,77 cases) and medium ablation rate group(diameter reduction rate between 50% and 75%, 132 cases) and high ablation rate(diameter reduction> 75%, 179 cases). After 6 months of follow-up, the diameter, location and MRI signal strength of uterine fibroids in the three groups were compared, and multivariate Logisitic regression analysis was performed on statistically significant indicators to explore the factors influencing the high efficacy of high-intensity focused ultrasound in the treatment of uterine fibroids. Results The uterine fibroids in the low ablation rate group were mainly <30 mm in diameter, and the location of fibroids was mainly in the posterior wall, lateral wall and fundus. In the medium ablation rate group, the fibroids were mainly 30 to 50 mm in diameter, and the location was mainly in the anterior wall. In the high ablation rate group, the fibroids were mainly >50 mm in diameter, and the location of fibroids was mainly in the anterior wall. The difference was statistically significant(P<0.05). The proportion of T1WI enhancement intensity and T2WI signal intensity in the higher of the three groups showed low ablation rate group > medium ablation rate group > high ablation rate group, and the difference was statistically significant when comparing the distribution of the three groups(P<0.05). Multi-factor Logisitic regression analysis showed that uterine fibroid diameter > 50 mm, location of anterior wall, low T1WI enhancement intensity and low T2WI signal intensity were factors influencing the high efficacy of high-intensity focused ultrasound in women with uterine fibroids. Conclusions The efficacy of high-intensity focused ultrasound in women with uterine fibroids is related to the diameter, location, T1WI enhancement and T2WI signal intensity of uterine fibroids, and should be taken into account clinically.