超声引导局部浸润麻醉下微波消融治疗子宫肌层良性病变的疗效评估和相关因素分析

Therapeutic effect evaluation of microwave ablation for uterine benign lesions under ultrasound-guidedlocal infiltration anesthesia and analysis of associated influencing factors

目的:探究超声引导局部浸润麻醉下微波消融治疗子宫肌瘤和子宫腺肌病的疗效及影响疗效的相关因素。方法:按照纳入和排除标准,回顾性收集2022年1月—2023年12月因症状性子宫肌层良性病变就诊于中国医科大学附属盛京医院接受超声引导局部浸润麻醉下微波消融治疗的患者63例,分别在微波消融术后1、3、6月对患者进行随访,评估消融效果及临床治疗效果,对患者的基线特征、临床数据与疗效进行相关性分析。结果:共计17名患者完成了6月的随访,子宫和病灶无灌注区体积与之前相比均明显减小(P<0.05),呈逐步下降趋势,最终子宫体积缩小率为44.3%(41.6%~58.2%),病灶无灌注区体积缩小率为76.6%(65.3%~84.0%),11名患者(64.7%)治疗效果非常显著,6名患者(35.3%)治疗效果显著,术后无严重并发症发生。在随访第1、3、6月时,子宫体积缩小率与BMI、子宫体积具有相关性;在随访第1、3月时,病灶无灌注区体积缩小率与单位体积消融总能量、病灶体积具有相关性。结论:超声引导局部浸润麻醉下微波消融治疗子宫肌瘤和子宫腺肌病具有良好的安全性和有效性。

Objective:To investigate the therapeutic efficacy of microwave ablation for uterine fibroids and adenomyosis under ultrasound-guided local infiltration anesthesia and explore the associated influencing factors.Methods:According to the inclusion and exclusion criteria,63 patients who received microwave ablation for symptomatic uterine benign lesions under ultrasound-guided local infiltration anesthesia in Shengjing Hospital of China Medical University were retrospectively collected from January 2022 to December 2023.The therapeutic efficacy of microwave ablation was assessed at 1-,3-,6-month follow-ups.Correlation analysis was performed to explore the relationship between the basic clinical information of the patients and the therapeutic efficacy.Results:A total of 17 patients completed the 6-month follow-up.Both uterine volume and nonperfused zone volume of lesion were significantly decreased compared with the last examination(P<0.05),showing a gradual descending,with a final uterine volume reduction rate of 44.3%(41.6%~58.2%)and a non-perfused zone volume of lesion reduction rate of 76.6%(65.3%~84.0%)The therapeutic efficacy in 11 patients(64.7%)was very significant,and 6 patients(35.3%)was significant with no serious postoperative complications.The uterine volume reduction rate correlated with BMI and uterine volume at 1-,3-,and 6-month follow-ups,and non-perfused zone volume of lesion reduction rate correlated with total ablation energy per unit volume and lesion volume at 1-,3-month follow-ups.Conclusion:Microwave ablation for uterine fibroids and adenomyosis under ultrasound-guided local infiltration anesthesia has good safety and efficacy.