经腹经阴道超声联合引导经皮穿刺消融特殊部位子宫良性病变的可行性

Feasibility of Percutaneous Ablation of Uterine Benign Lesions in Special Parts Guided by Transabdominal Combined with Transvaginal Ultrasound

目的探讨经腹经阴道超声联合引导经皮穿刺微波消融特殊部位子宫良性病变的可行性及安全性。资料与方法回顾性分析症状性子宫良性病变37例。于静脉麻醉下行经腹及经阴道超声扫查、超声造影、人工腹水建立、穿刺活检、消融治疗,将病灶位于浆膜下毗邻直肠的子宫良性病变患者根据穿刺路径是否经过宫腔或是否为黏膜下子宫肌瘤分为经腹超声引导组18例和联合超声引导组19例,比较两组消融过程的超声显示清晰度、疗效和短期并发症情况。结果37例患者中,子宫肌瘤27例,子宫腺肌症10例。经腹超声引导组和联合超声引导组病变类型差异无统计学意义(P>0.05)。联合超声引导组病灶19个,消融过程中均可完整清晰显示;经腹超声引导组病灶21个,受消融气体影响,消融灶后方均难以显示。经腹超声引导组17例进行阴道塞纱,2例建立人工腹水;联合超声引导组均未进行阴道塞纱和人工腹水建立。术后经腹超声引导组中16个病灶进行补充消融,联合超声引导组中9个病灶进行补充消融,补充消融率差异无统计学意义(χ^(2)=3.536,P>0.05)。两组子宫肌瘤完全消融率差异无统计学意义(χ^(2)=1.076,P>0.05)。两组患者均未出现C级以上严重并发症。两组术后并发症差异无统计学意义(χ^(2)=3.633,P>0.05)。结论经腹经阴道联合超声引导子宫特殊部位良性病变可显著增加消融灶及其周边组织的超声显示率,对安全有效地实施子宫良性病变的消融治疗具有重要意义。

Purpose To explore the feasibility and safety of transabdominal combined with transvaginal ultrasound in guiding percutaneous microwave ablation of uterine benign lesions in special parts. Materials and Methods Thirty-seven patients with symptomatic uterine benign lesions were retrospectively analyzed. Transabdominal and transvaginal ultrasound scanning, contrast-enhanced ultrasound, artificial ascites establishment, puncture biopsy, and ablation therapy were performed under intravenous anesthesia. Patients with benign uterine lesions located under the serous membrane and adjacent to the rectum were divided into transabdominal ultrasound guided group(18 patients) and combined ultrasound guided group(19 patients) according to whether the puncture path passed through the uterine cavity or whether it was submucosal uterine fibroid, and the ultrasound display clarity, curative effect, short-term complications of the ablation process were further compared between the transabdominal ultrasound-guided group and the combined ultrasound-guided group. Results Twenty-seven patients with uterine fibroids and 10 patients with adenomyosis were included. There was no significant difference in the types of lesions between the two groups(P>0.05). There were 19 lesions in the combined ultrasound-guided group, which could be displayed completely and clearly during ablation, and 21 lesions in the transabdominal ultrasound-guided group were affected by gas, and it was difficult to display behind the ablation lesions. In the transabdominal ultrasound-guided group, 17 cases received vaginal plug gauze and 2 cases had artificial ascites. In the combined ultrasound-guided group, neither vaginal plug gauze nor artificial ascites was established. After the operation, 16 lesions in the transabdominal ultrasound-guided group were supplemented with ablation, and 9 lesions in the combined ultrasound-guided group were supplemented with ablation. There was no significant difference in the supplemental ablation rate(χ2=3.536, P>0.05). There was no significant difference in the complete ablation rate of uterine fibroids between the two groups(χ2=1.076, P>0.05). There were no serious complications above grade C in the two groups. There was no significant difference in postoperative complications between the two groups(χ2=3.633, P>0.05). Conclusion The combination of transabdominal and transvaginal ultrasound to guide benign lesions in special parts of the uterus can significantly increase the ultrasound display rate of the ablation area and its surrounding tissues, which is of great significance for the safe and effective implementation of ablation treatment of benign uterine lesions.