基于MRI特征的不同类型子宫腺肌病采用聚焦超声消融治疗的临床研究

Clinical study of focused ultrasound ablation for different types of adenomyosis based on MRI characteristics

目的通过对比分析不同类型子宫腺肌病的MRI特征,研究联合采用聚焦超声消融技术治疗的临床效果。方法回顾性分析绵阳市中心医院2019年3月至2021年12月收治的220例采用聚焦超声消融治疗的子宫腺肌病患者,年龄19~52岁,中位年龄43岁;病程1~27年,中位病程为3年;身体质量指数(BMI)17.2~33.7 kg/m^(2),中位BMI22.7 kg/m^(2);单发病灶95例,多发病灶125例;痛经203例,经量增多125例,痛经合并经量增多94例。根据术前盆腔MRI检测的病灶和侵入程度分为4个亚型。采用聚焦超声消融治疗,分析4个亚型子宫腺肌病的治疗情况和不良反应,对比分析术后病灶变化情况、经量及痛经缓解等情况。结果参照Kishi分型,患者术前的MRI结果分成4个亚型,其中78例为Ⅰ型(35.5%),71例为Ⅱ型(32.3%),28例为Ⅲ型(12.7%),43例为Ⅳ型(19.5%)。所有患者在镇静镇痛作用下均完成治疗,所有患者术后病灶体积均缩小,且缩小率随时间而逐渐增加。在手术6个月后,Ⅲ型病灶缩小率(69.7%±13.7%)较其他3个亚型的更大(P<0.05),病灶缩小率Ⅱ型(51.1%±23.8%)、Ⅰ型(49.6%±22.1%)、Ⅳ型(44.4%±27.8%)组间对比,差异无统计学意义。所有患者术后的月经量评分均随时间逐渐减少,其中Ⅲ型患者术后6个月的经量增多缓解率(100.0%)明显高于其他3个亚型(88.4%、88.1%、66.7%),差异有统计学意义(P<0.05)。所有患者术后的痛经评分均随时间逐渐降低,其中Ⅲ型患者术后6个月的痛经缓解率(100.0%)明显高于其他3个亚型(87.0%、89.2%、83.3%),差异有统计学意义(P<0.05)。4个亚型患者不良反应均为A级和B级。发生率比较,差异均无统计学意义。结论聚焦超声消融对不同类型的子宫腺肌病的临床治疗具有安全性和有效性,且子宫腺肌病的不同亚型疗效差异明显,其中该手段在Ⅲ型患者中疗效最佳。

Objective To study the combined use of focused ultrasound ablation technology for clinical treatment by comparative analysis of MRI characteristics of different types of adenomyosis. Methods From March 2019 to December 2021, 220patients with adenomyosis treated with focused ultrasound ablation were enrolled, which aged 19-52 years old with median age of 43 years old;course of disease was 1-27 years with median course of 3 years;body mass index(BMI) was 17.2-33.7 kg/m^(2)with mean BMI of 22.7 kg/m^(2). There were 95 cases of single lesion and 125 of multiple lesions;203 cases of dysmenorrhea,125 of increased menstruation and 94 of dysmenorrhea combined with increased menstruation. All of the patients were divided into 4 subtypes according to lesion and invasion degree detected by preoperative pelvic MRI. The focused ultrasound ablation was used to analyze the treatment and adverse reactions of 4 subtypes of adenomyosis, and changes of lesions, menstrual volume and dysmenorrhea relief were compared and analyzed. Results According to Kishi classification, the preoperative MRI results of the patients were divided into 4 subtypes, of which 78 cases of type Ⅰ(35.5 %), 71 of type Ⅱ(32.3 %), 28 of type Ⅲ(12.7 %) and 43 of type Ⅳ(19.5 %). All of the patients completed treatment under the effect of sedation and analgesia, the lesion volumes were decreased after operation and reduction rate increased with time. At 6th month after operation, the lesion reduction rate of type Ⅲ(69.7 % ± 13.7 %) was higher than that of the other 3 subtypes(P<0.05), and there was no significant difference among the three groups of type Ⅱ( 51.1 % ± 23.8 %), type Ⅰ(49.6 % ± 22.1 %) and type Ⅳ(44.4 % ± 27.8 %). The menstrual volume score of all patients decreased gradually with time, the remission rate of increased menstrual volume in type Ⅲ(100.0 %) was significantly higher than that in the other 3 subtypes(88.4 %, 88.1 %, 66.7 %) at 6th month after operation, and the differences were statistically significant(P<0.05). The dysmenorrhea score of all patients decreased gradually with time, the dysmenorrhea remission rate of type Ⅲ(100.0 %) was significantly higher than that of the other 3 subtypes(87.0 %, 89.2 %, 83.3 %) at 6-month after operation, and the differences were statistically significant(P<0.05). The adverse reactions of 4 subtypes were grade A and B, and there was no statistically significant difference in incidence rates. Conclusion It is demonstrated that focused ultrasound ablation is safe and effective in clinical treatment of different types of adenomyosis, and the efficacy of different subtypes of adenomyosis is significantly different, and the method has the best therapeutic effect in type Ⅲ patients.