高强度聚焦超声消融子宫肌瘤的MRI评价  

Evaluation of the effect of ablating uterine leiomyoma with high intensity focused ultrasound in patients by MRI

作　　者：杨武威[1] 盖绿华[1] 李静[1] 夏文秀[1] 祝宝让[1] 张彦[2] 黄长江[3] 卞丽红[3] 杨涛[2] 

机构地区：[1]解放军第307医院超声聚焦刀科,北京100071 [2]解放军第307医院超声科,北京100071 [3]解放军第307医院妇科,北京100071

出　　处：《解放军医学杂志》2009年第5期616-618,共3页Medical Journal of Chinese People's Liberation Army

摘　　要：目的观察高强度聚焦超声(HIFU)消融治疗子宫肌瘤的客观疗效、不良反应和临床转归情况。方法2006年12月-2008年3月解放军第307医院参与多中心临床验证的子宫肌瘤确诊患者38例(包括多发肌瘤患者17例),使用HIFU治疗系统一次性消融治疗子宫肌瘤47个,其中肌瘤最大直径11.6cm。观察不良反应并定期随访,随访期间应用增强磁共振(MRI)评价HIFU治疗后子宫肌瘤的消融坏死体积及消融率,测量治疗后子宫和肌瘤体积的变化,判断临床转归规律。结果治疗后随访37例共46个肌瘤,增强MRI显示所有肌瘤均出现消融坏死区并持续存在,HIFU消融率为65.1%±21.7%。与治疗前相比,治疗后不同时间子宫和肌瘤体积均有显著缩小,1、3、6、12个月时子宫肌瘤的缩小率分别为24.1%±17.3%、39.8%±23.4%、44.6%±24.7%、60.3%±17.2%(F=15.31,P<0.01),呈现出随时间延长逐渐缩小的变化规律。HIFU治疗后的主要并发症为局部疼痛、发热等,均为轻中度,并可在1周内自行缓解。结论HIFU消融治疗子宫肌瘤安全可行,局部消融效果确切。Objective To evaluate the safety and effect of high intensity focused ultrasound （HIFU） on ablating uterine leiomyoma by magnetic resonance imaging （MRI）. Methods From Dec. 2006 to Mar. 2008, 38 patients （including 17 patients with multiple uterine leiomyoma） were admitted in 307 Hospital of PLA. The tumor therapeutic system HIFU model JC was used to ablate 47 uterine leiomyomak, of which the maximum tumor diameter was 11.6cm. Periodic follow-up was done and the enhanced magnetic resonance imaging （MRI） was used to evaluated the ablated necrosis volume, ablation rate of uterine leiomyoma, and uterus and leiomyoma volumes were measured at 1, 3, 6 and 12 months after HIFU ablation. Furthermore, the side-effects were observed during and after HIFU ablation. Results Thirty seven （including 46 uterine leiomyoma） of 38 patients were followed-up and the efficacy was evaluated. The necrotic area had been found in the ablated leiomyoma, which existed for a long time, after HIFU treatment by enhanced MRI. The nacrosis rate was 65. 1%±21.7%. Uterus and leiomyoma volumes reduced gradually following the HIFU treatment. The average reduction rates of uterine leiomyoma at 1, 3, 6 and 12 months were 24. 1%±17.3%, 39. 8%±23. 4%, 44. 6%±24. 7% and 60. 3%±17. 2%, respectively （F=15. 31, P〈0. 01）. The main complications of HIFU treatment was slight topical pain and fever, which might be relievable voluntarily in one week after HIFU. Conclusion HIFU may provide an feasible, effective and safe method of treating uterine leiomyoma.

关 键 词：超声 高强聚焦 子宫肌瘤 磁共振成像 

分 类 号：R737.33[医药卫生—肿瘤] R454.14[医药卫生—临床医学]