聚焦超声消融手术治疗腹壁子宫内膜异位症的临床应用价值探讨

Clinical value of focused ultrasound ablation surgery in the treatment of abdominal wall endometriosis

目的分析聚焦超声消融手术(FUAS)治疗腹壁子宫内膜异位症(AWE)的有效性、安全性。方法收集2019年11月至2022年10月青岛市妇女儿童医院收治的行FUAS治疗的AWE患者共34例,回顾性分析其临床特征、影像学特征、FUAS治疗的相关情况及治疗后不良反应,并随访其症状改善及复发再干预情况。结果 (1)患者的临床资料特点:34例AWE患者的年龄为(32.8±3.8)岁,病灶最大径的中位数为24 mm(最小值为15 mm,最大值为48 mm);治疗前腹壁病灶周期性疼痛为中、重度者30例(88%,30/34);治疗前行磁共振成像检查显示浅表型19例(56%,19/34),中间型8例(24%,8/34),深部型7例(21%,7/34)。(2)FUAS治疗参数:手术时间为(64±18)min,辐照时间为(385±108)s,治疗功率为(103±11)W,治疗总能量为(38 819±16 309)J,治疗区域体积为(3.11±1.42)cm3,治疗强度为(377.79±106.34)s/h。(3)有效性结果:FUAS治疗后1个月、3个月、6个月、1年疼痛较治疗前明显缓解,疼痛评分较治疗前显著下降(Z=-4.66、-5.13、-5.11、-4.91,P均<0.01)。随访至FUAS治疗后1年,疼痛基本缓解及有效缓解者的占比为74%(25/34),临床治疗有效率为85%(29/34)。随访至治疗后1年,共5例患者复发,其中3例复发后行经腹AWE病灶切除术,2例予药物治疗。FUAS治疗后1个月病灶最大径较治疗前无明显变化(P>0.05),但治疗后3个月、6个月、1年病灶最大径较治疗前显著缩小(Z=-2.15、-2.67、-3.41,P均<0.05)。不同分型的AWE患者疼痛缓解情况无差异(P>0.05),病灶最大径的缩小情况存在显著差异(P均<0.01)。(4)安全性结果:FUAS治疗中34例患者均诉皮肤热烫感,19例(56%,19/34)患者出现术后治疗区疼痛,2例(6%,2/34)患者术后即刻血尿,经相应处理后均好转或症状消失。结论 FUAS治疗AWE是有效、安全的,初步验证了其临床应用价值。

Objective To explore the effectiveness and safety of focused ultrasound ablation surgery(FUAS)for abdominal wall endometriosis.Methods From November 2019 to October 2022,a total of 34 patients with abdominal wall endometriosis who underwent FUAS were collected,and their clinical features,imaging features,intraoperative treatment and side effects after treatment were analyzed retrospectively,and the improvement of symptoms and re-intervention were followed up.Results(1)Characteristics of clinical data:the average age of 34 patients with abdominal wall endometriosis was(32.8±3.8)years old.The largest diameter of the lesion was 48 mm,and the median lesion diameter was 24 mm.Thirty cases(88%,30/34)had moderate to severe periodic pain in abdominal incision before FUAS.All patients were diagnosed by preoperative magnetic resonance imaging,including 19 cases(56%,19/34)of superficial type,8 cases(24%,8/34)of intermediate type and 7 cases(21%,7/34)of deep type.(2)FUAS treatment parameters:ablation was completed with average operation time of(64±18)minutes,average sonication time was(385±108)s,(103±11)W of average power,(38819±16309)J of average total energy,the average treatment area volume of(3.11±1.42)cm3,and(377.79±106.34)s/h of average treatment intensity.(3)Efficiency:the pain of patients after FUAS was significantly relieved,and the pain scores of patients after 1 month,3 months,6 months and 1 year after FUAS were significantly decreased(Z=-4.66,-5.13,-5.11 and-4.91,all P<0.01).One year after FUAS,the near relief and effective pain relief rate was 74%(25/34),and the clinical effective rate was 85%(29/34).Five patients recurred after one year,including 3 patients who underwent abdominal wall endometriosis lesion resection and 2 patients who received drug treatment.One month after FUAS,the size of the lesion did not change significantly compared with that before FUAS(P>0.05),and the size of the lesion decreased significantly after FUAS at 3 months,6 months and 1 year(Z=-2.15,-2.67 and-3.41,all P<0.05).It has no difference in pain relief among different types(P>0.05),but has significant difference in focus reduction among three types(P<0.01).(4)Safety:there were 34 cases(100%,34/34)of skin burning sensation,19 cases(56%,19/34)of pain in the treatment area and 2 cases(6%,2/34)of hematuria.All patients got better after corresponding treatments.Conclusion FUAS is safe and effective for the treatment of abdominal wall endometriosis,which has clinical application value.