聚焦超声消融治疗不同型别子宫腺肌病的临床疗效比较

Comparison of clinical efficacies of focused ultrasound ablation in treating different types of adenomyosis

目的比较基于磁共振(MRI)特征不同型别子宫腺肌病聚焦超声消融(FUA)治疗后的临床疗效。方法纳入2014年1月至2019年12月在遂宁市中心医院行FUA治疗的子宫腺肌病患者227例,根据术前盆腔MRI检查,根据病灶位置将其分为4个亚型,其中Ⅰ型(内生型)82例,Ⅱ型(外生型)75例,Ⅲ型(结节型)34例,Ⅳ型(异质型)36例。对比分析4种亚型子宫腺肌病FUA治疗结果及术后不良反应,对比术后3、6个月病灶体积变化情况、痛经及月经量情况。结果所有患者均在镇静镇痛下顺利完成FUA治疗,按国防放射介入学会(SIR)分级发生A级不良反应51例(22.47%),B级不良反应3例(1.32%),无C~F级不良反应发生,各型A、B级不良反应的发生率比较差异无统计学意义(P>0.05)。Ⅲ型患者病灶消融率(NPVR)明显高于其他3型(P<0.05),Ⅰ、Ⅱ、Ⅳ型间两两比较,病灶NPVR差异无统计学意义(P>0.05)。治疗前后病灶体积变化:所有患者治疗后病灶体积较术前均有缩小,缩小率随时间增加逐渐增大。术后6个月,Ⅲ型患者病灶缩小率大于其他3型(P<0.05),Ⅰ型、Ⅱ型、Ⅳ型间两两比较,病灶缩小率差异无统计学意义(P>0.05)。月经量增多症状缓解情况:术后6个月,Ⅲ型患者的月经量增多症状总缓解率100%,而Ⅳ型患者的月经量增多症状总缓解率低于Ⅰ、Ⅱ、Ⅲ型(P<0.05),无效患者比例较高。痛经症状缓解情况:术后6个月,Ⅲ型患者的痛经症状总缓解率100%,完全缓解率(58.1%,18/31)高于其他3型(P<0.05)。结论FUA治疗不同类型子宫腺肌病是安全有效的,但不同腺肌病亚型间疗效存在差异,Ⅲ型子宫腺肌病患者行FUA的治疗效果优于其他3型。

Objective To compare the clinical efficacies of focused ultrasound ablation(FUA)in the treatment of different types of adenomyosis.Methods A total of 227 patients with adenomyosis treated with FUA in Suining Municipal Central Hospital from January 2014 to December 2019 were enrolled and divided into four subtypes according to preoperative pelvic cavity MRI examination,which were 82 cases in the typeⅠ(endogenous type),75 cases in the typeⅡ(exogenous type),34 cases in the typeⅢ(nodular type)and 36 cases in the typeⅣ(heterogeneity type).The treatment results and adverse effects were compared among the four subtypes of adenomyosis.The change of focus volume,and relief situation of dysmenorrhea and menstrual blood volume at the time of 3,6 months after operation were compared.Results All patients completed the FUA treatment under sedation and analgesia.The grade A adverse reactions according to the Estimated Radiological Interventional Society(SIR)classification occurred in 51 cases(22.47%),the grade B adverse reactions occurred in 3 cases(1.32%)and there was no grade C-F adverse reaction occurred.There was no statistically significant difference in the occurrence rates of grade A and grade B among different types of adenomyosis(P>0.05).The non-perfused volume ratio(NPVR)of lesion in typeⅢwas significantly higher than that with the other 3 types.The pairwise comparison of the typeⅠ,ⅡandⅣshowed that the lesion NPVR had no statistical significant difference(P>0.05).The lesion volume change before and after treatment:the lesion volume after treatment in all cases was decreased compared with that before operation,and the lesion reduction rate was gradually increased with the time increase.The reduction rate of lesion at the time of 6 months after opration in the patients with typeⅢwas greater than that of the patients with the other 3 types(P<0.05),and the lesion reduction rate had no statistically significant difference in the pairwise comparison among typeⅠ,typeⅡand typeⅣ.The remission situation of menorrhagia:the total remission rate at the time of 6 months after operation in the patients with typeⅢwas 100%,the total remission rate of menorrhagia in the patients with typeⅣwas lower than that in the patients with typeⅠ,ⅡandⅢ(P<0.05),and the proportion of the patients with ineffectiveness was high.The relief situation of dysmenorrhea:the total relief rate of dysmenorrhea at the time of 6 months after operation in the patients with typeⅢwas 100%,and the complete remission rate(58.1%,18/31)was higher than that in the patients with the other 3 types(P<0.05).Conclusion FUA is safe and effective in treating different types of adenomyosis,but the difference of efficacy exists among different types of adenomyosis,the treatment efficacy of FUA in the typeⅢadenomyosis is better than that in the other three types.