子宫肌瘤的血液供应特征对超声消融治疗剂量的影响  

Doppler flow imaging characteristics of blood supply of uterine fibroids on the therapeutic dosage of ultrasound ablation

作　　者：陈锦云[1] 陈文直[1] 朱丽[1] 唐良萏[2] 邓勇斌[3] 刘映江[3] 邹建中[1] 白晋[1] 王智彪[1] 

机构地区：[1]重庆医科大学生物医学工程学院,400016 [2]重庆医科大学附属第一医院妇产科,400016 [3]重庆医科大学超声医疗国家工程研究中心,400016

出　　处：《中华妇产科杂志》2011年第6期403-406,共4页Chinese Journal of Obstetrics and Gynecology

基　　金：国家自然科学基金（30830040）;重庆市自然科学基金（2009BB5260）

摘　　要：目的探讨子宫肌瘤的血液供应特征对超声消融治疗剂量的影响。方法2006年12月至2009年1月，对重庆医科大学附属第一医院妇产科就诊的142例患者的168个肌瘤行超声消融治疗。治疗前采用彩色多普勒超声将靶肌瘤血液供应分为0～4级（因有3例患者的3个肌瘤未完成治疗后1个月内的增强MRI评估，故165个肌瘤纳入分析），血液供应为0级的肌瘤9个、1级34个、2级35个、3级55个、4级32个。治疗后1个月内增强MRI检查测量无灌注区的面积并计算肌瘤体积消融率及其能效因子（EEF，即单位体积肌瘤行超声消融治疗所需能量），比较不同血液供应状态对治疗剂量的影响。根据国际介入放射治疗学会（SIR）的标准，评价治疗相关的副反应发生情况并进行治疗过程中的疼痛评分。结果（1）体积消融率：0～4级血液供应肌瘤体积消融率分别为79％、89％、92％、86％、71％，0级与2、3级血液供应肌瘤的体积消融率比较，差异有统计学意义（P〈0．05）；4级与1、2、3级血液供应肌瘤的体积消融率比较，差异也有统计学意义（P〈0．05）。（2）EEF：0～4级血液供应肌瘤消融所需EEF分别为13．19、9．54、12．91、17．83、28．10J／ram。，4级血液供应肌瘤消融所需EEF明显高于1、2、3级血液供应肌瘤，差异有统计学意义（P〈0．05）；肌瘤血液供应与消融所需EEF呈正相关关系（r：0．354，P〈0．01）。（3）治疗过程中疼痛评分及副反应发生情况：近85％（120／142）的患者对治疗过程可以较好耐受，治疗过程中疼痛评分均为0～4分。全部病例均无延长住院时间等SIR标准中C～F并发症发生。结论子宫肌瘤超声下的血液供应特征可用于预测超声消融剂量，为临床选择超声消融治疗子宫肌瘤的适宜剂量提供依据。Objective To explore the relationship between therapeutic dosage of ultrasound ablation in treatment of uterine fibroids and imaging characteristics of bloody supply of uterine fibroids by color Doppler ultrasound imaging. Methods One hundred and forty-two patients with 168 fibroids were treated by ultrasound ablation. Before treatment, bloody supply of fibroids were classified into grade 0 - 4 by uhrasonography. Three patients lost follow-up with contrast MRI exam within 1 month after treatment, so 165 fibroids were enrolled in this study. Bloody supplies were 9 fibroids in grade 0, 34 fibroids in grade 1, 35 fihroids in grade 2, 55 fibroids in grade 3 and 32 fibroids in grade 4. After 1 month treatment, the treated area without blood supply and ratio of ablation were measured by contrast MRI to evaluate the efficacy of thermal ablation and compare status of blcod supple based different therapeutic dosage. According to International Reditherapy for Society （ SIR ） standard, adverse effect and score of pain were evaluated. Results （ 1 ） Ratio of ablation bas,ed ： ratios of ablation were 79% in grade 0, 89% in grade 1, 92% in grade 2, 86% in grade 3, 71% in grade 4. grade 0 compared with those of grade 2 and 3 （ P 〈 0 It reached statistical difference when blood supply of 05 ） and blood supply of grade 4 compared with those of grade 1, 2, 3 （P 〈 0. 05 ）. （2） Factor of energy efficiency ： factor of energy efficiency were 13.19 J/mm3 in degree O, 9. 54 J/mm3 in degree 1 , 12. 91 J/mm3 in degree 2, 17.83 J/mm3 in degree 3 and 28.10 J/mm3 in degree 4. Factor of energy of ablation in degree 4 was significantly higher than those in degree 1, 2 and 3 blood supply （ P 〈 0.05 ）. It exhibit the positive relationship between blood supply and factor of energy of ablation （ r = 0.354,P 〈 0.01 ）. （ 3 ） Score of pain and adverse effect ： nearly 85% （ 120/142 ） patients could tolerate this treatment very well. Those scores of pain were in range of 0 to 4. All patients did not exte

关 键 词：子宫肿瘤 平滑肌瘤 超声检查 多普勒 彩色 磁共振成像 导管消融术 

分 类 号：R737.33[医药卫生—肿瘤]