经皮微波凝固子宫肌瘤效果研究  

The study of percutaneous microwave coagulation for uterine myomas

作　　者：张晶[1] 冯蕾[1] 张冰松[1] 任金涛[1] 李振彩[1] 温博[1] 胡冬梅[1] 蒋雪[1] 杜领娣[1] 

机构地区：[1]解放军总医院第一附属医院超声科,北京100037

出　　处：《中华医学超声杂志（电子版）》2011年第1期40-43,共4页Chinese Journal of Medical Ultrasound(Electronic Edition)

基　　金：解放军总医院苗圃基金及解放军总医院第一附属医院临床新技术课题资助项目(06MP57;ZD200806)

摘　　要：目的探讨经皮穿刺微波凝固子宫肌瘤的有效性与安全性。方法超声引导下经皮穿刺于24例患者的27个子宫肌瘤内植入微波天线进行凝固治疗。治疗前后经皮穿刺子宫肌瘤活检组织均行病理检查。治疗过程中记录患者反应。术后随访30d,记录有无并发症及副作用。治疗前、后均行静脉超声造影及增强MRI检查,评价子宫肌瘤坏死情况及消融区周围组织结构变化。结果对24例患者的27个子宫肌瘤结节行超声引导下微波热凝固治疗。27个子宫肌瘤中13个肌壁间子宫肌瘤,11个浆膜下子宫肌瘤,3个黏膜下子宫肌瘤。子宫肌瘤结节均径2.7～8.6cm,平均(5.6±1.5)cm。子宫肌瘤体积9.8～329.0cm3,平均(111.2±80.2)cm3。治疗结束后即刻经静脉超声造影26个子宫肌瘤无造影剂充盈,1个子宫肌瘤约50%无增强,即刻行2次凝固至结节无明显增强。治疗后穿刺子宫肌瘤组织病理检查显示子宫肌瘤呈凝固性坏死。局麻患者治疗开始约100s后感下腹部热、涨,但均能耐受,停止发射微波能量后患者疼痛逐渐消失。治疗结束后22例患者无明显不适,2例感下腹部及腰部不适,无需服用止痛药,8～12h后不适感自行消失。治疗中及治疗后无一例并发症发生。治疗后全部患者当月月经来潮。结论超声引导经皮穿刺微波凝固治疗可有效灭活子宫肌瘤,子宫正常肌组织不受到破坏。经皮微波凝固子宫肌瘤有望成为子宫肌瘤保守治疗的有效方法。Objective To evaluate the coagulation effect of uterine myoma by percutaneous micro- wave （MW）. Methods The MW antenna was percutaneously inserted into the myoma under ultrasound guidance. Symptom description and side effects were recorded in the period of coagulation and after treat- ment. The size of tumor necrosis was evaluated by contrast sonography and enhanced MRI. Results Twen- ty-seven myomas in 24 patients were coagulated. Thirteen intramural nodes were intramural in the 27 nod- ules, 11 are subserosal fibroid and 3 are submucous myoma. Baseline valaes of the mean diameter and vol- ume of myoma were 2.7-8.6 cm with a mean of（ 5.6 -＋ 1.5 ） cm. The volume was （9.8-329.0） crn3 with a mean of（ 111.2 -＋ 80.2 ） cm3. Among the 27 coagulated nodules, 26 had no increase by contrast ultrasonogra- phy. One nodule had 50% of no-enhancement in the first session of coagulation and by re-coagulation. After coagulation the pathological examination of biopsy myoma revealed that the tissue of myoma was necrosis. Af- ter 100s of MW eradiating, all of the patients with local anaesthesia complained about sense of heat and swell in low abdomen and the sense automatically disappeared after MW irradiation stopped. After treatment, 22 patients recovered and 2 subjects had pain sense in low abdomen and waist without anodyne and the sense gradually.disappeared after 8 hours. None of complications was observed in all of patients in the period of co- agulation and after coagulation. The patients have their normal menstruate in the month of treatment. Conclusions The percutaneous MW coagulation of uterine myoma can put to death of myoma cells with preserved uterine normal tissue under ultrasound gudiance.

关 键 词：超声检查 微波凝固 子宫肌瘤 治疗 

分 类 号：R737.33[医药卫生—肿瘤]