高强度聚焦超声对子宫平滑肌瘤微血管的破坏作用  

Vessel damage resulting from high intensity focused ultrasound treatment in patients with uterine leiomyoma

作　　者：周晓东[1] 任小龙[1] 何光彬[1] 张军[1] 罗文[1] 田雪[1] 刘丽文[1] 郑敏娟[1] 李利[1] 张海滨[1] 

机构地区：[1]第四军医大学西京医院超声科,西安710032

出　　处：《中华超声影像学杂志》2007年第5期424-427,共4页Chinese Journal of Ultrasonography

基　　金：国家自然科学基金资助项目（30570489）

摘　　要：目的 探讨高强度聚焦超声（HIFU）在治疗子宫平滑肌瘤中对微血管的破坏作用。方法 114例患者共175个子宫肌瘤行HIFU治疗，分别于治疗前后1周同时行彩色多普勒血流显像（CDFI）和实时超声造影（CEUS）检查，分析HIFU治疗后瘤体血流灌注情况。其中64个肌瘤术前、术后行超声引导下穿刺活检，用免疫组化法对标本用CD31单克隆抗体进行肿瘤血管内皮染色，计数肿瘤微血管密度（MVD），分析比较HIFU治疗前后MVD变化情况。结果 175个子宫肌瘤行HIFU治疗后，CDFI在143个肌瘤内未测及任何血流信号，24个肌瘤血流信号明显减少，8个肌瘤血流信号无明显变化；CEUS在141个肌瘤内显示造影剂完全充盈缺损，13个肌瘤瘤体内大部分组织充盈缺损，周边有局灶性增强，21个肌瘤显示为造影剂弥漫增强。术前64例活检组织免疫组化染色MVD计数平均为60．3±17．0；术后显示微血管大量破坏，64例组织MVD计数平均12．1±16．3，术前、术后MVD比较差异有统计学意义（P〈0．001）。结论 HIFU能从体外破坏肿瘤血管，加强了HIFU杀死子宫平滑肌瘤细胞的直接效应。Objective To explore the vessel damage effect in patients with uterine leiomyoma after extracorporeal treatment with high intensity focused ultrasound（HIFU）. Methods A total of 114 patients with 175 uterine leiomyomas were treated with HIFU. Color Doppler flow imaging（CDFI） and contrast enhanced ultrasonography（CEUS） were performed one week before and after HIFU treatment respectively. Of these patients, ultrasound guided needle puncture biopsy was performed in 64 uterine leiomyomas one week before and after HIFU treatment respectively. Microvessel density（MVD） was examined by use of immunohistochemical staining. Results Of these 175 uterine leiomyomas,CDFI showed no blood signal in 143 leiomyomas after HIFU treatment, 24 leiomyomas showed obvious decreased blood signal, and 8 leiomyomas showed no obvious blood signal change. CEUS showed no contrast agent enhancement in 141 leiomyomas after HIFU treatment, 13 leiomyomas showed marginal focal enhancement and 21 leiomyomas showed diffuse enhancement indicating failed HIFU treatment. MVD was significantly lower in posttreatment specimens than in pre-treatment specimens（ 12.1±16.3 vs 60.3 ± 17.0, P 〈0. 001 ）. Conclusions HIFU can extracorporeally destroy tumor vessels in uterine leiomyoma, then indirectly strengthen the destructive effect of HIFU treatment on tumor tissues.

关 键 词：超声检查 造影剂 子宫肿瘤 平滑肌瘤 高强度聚焦超声 

分 类 号：R686[医药卫生—骨科学]