高强度聚焦超声治疗子宫肌瘤致腹壁皮肤热损伤的影响因素

Impact factors of abdominal wall skin thermal injury after high intensity focused ultrasound of uterine fibroids

目的分析高强度聚焦超声(HIFU)治疗子宫肌瘤致腹壁皮肤热损伤的影响因素。方法回顾性分析260例接受HIFU治疗的子宫肌瘤患者,对比52例治疗后出现治疗区域腹壁皮肤热损伤(皮损组)与208例无皮肤热损伤患者(对照组)的一般资料、肌瘤特征及治疗相关参数,采用多因素logistic回归分析发生皮肤热损伤的影响因素。结果组间腹壁瘢痕及皮下脂肪厚度、肌瘤T2WI呈高/混杂信号、治疗时间、辐照时间、治疗能量及声通道疼痛反应差异均有统计学意义(P均<0.05);多因素分析显示,腹壁瘢痕[OR=2.956,95%CI(1.460,5.986),P=0.003]和皮下脂肪厚度[OR=1.050,95%CI(1.015,1.086),P=0.005]、肌瘤T2WI呈高/混杂信号[OR=2.250,95%CI(1.164,4.349),P=0.016]及声通道疼痛反应[OR=4.670,95%CI(2.360,9.241),P<0.001]均为皮肤热损伤的独立影响因素。结论HIFU治疗子宫肌瘤时,患者腹壁瘢痕及皮下脂肪厚度、肌瘤T2WI信号及声通道疼痛反应均为致腹壁皮肤热损伤的影响因素。

Objective To explore the impact factors of abdominal wall skin thermal injury after high intensity focused ultrasound(HIFU)of uterine fibroids.Methods Data of 260 uterine fibroid patients who underwent HIFU were retrospectively analyzed,including 52 cases with(skin injury group)and 208 cases without(control group)abdominal skin thermal injury in the treated area after HIFU.The general data,preoperative MRI features of uterine fibroid and treatment parameters were compared between groups.Multiple logistic regression was then used to analyze the impact factors of skin thermal injury.Results There were significant differences of abdominal wall scar,subcutaneous fat thickness,high/mixed T2WI signals of uterine fibroid,sonication time,treatment time,ultrasound energy,acoustic channel pain response between groups(all P<0.05).Multiple logistic regression analysis showed that abdominal wall scar(OR=2.956,95%CI[1.460,5.986],P=0.003),subcutaneous fat thickness(OR=1.050,95%CI[1.015,1.086],P=0.005),high/mixed T2WI signals of uterine fibroid(OR=2.250,95%CI[1.164,4.349],P=0.016)and acoustic channel pain response(OR=4.670,95%CI[2.360,9.241],P<0.001)were independent impact factors of skin thermal injury.Conclusion Abdominal wall scar,subcutaneous fat thickness,high/mixed T2WI signals of uterine fibroid and acoustic channel pain response were all impact factors of abdominal skin injury after HIFU of uterine fibroid.