子宫肌瘤超声消融术后妊娠对靶肌瘤的影响及妊娠结局  

Effect of pregnancy on target fibroids and pregnancy outcome after ultrasound ablation

作　　者：李俊书[1] 陈文直[1] 胡亮[1] 王勇[1] 冯玉洁[1] 张蓉[2] 陈锦云[1,2] 

机构地区：[1]重庆医科大学生物医学工程学院省部共建国家重点实验室培育基地-重庆市超声医学工程重点实验室重庆市生物医学工程学重点实验室,重庆400016 [2]重庆医科大学附属第一医院超声消融治疗中心,重庆400042

出　　处：《中国介入影像与治疗学》2017年第5期278-282,共5页Chinese Journal of Interventional Imaging and Therapy

基　　金：国家"十二五"科技支撑计划课题项目(2011BAI14B01)

摘　　要：目的探讨子宫肌瘤行高强度聚焦超声(HIFU)消融治疗后妊娠者孕产期靶肌瘤的转归情况及妊娠结局。方法选择在我院接受HIFU治疗后妊娠者123例,收集临床资料、肌瘤的影像学特征信息,进行孕产期靶肌瘤相关情况随访。结果术后中位随访时间为3年,与妊娠前比较,60例(60/123,48.78%)患者孕早中期靶肌瘤增大,平均增大直径(2.1±1.6)cm;22例剖宫产+剔除靶肌瘤患者中,与孕前、孕早中期相比,分别有3例(3/22,13.63%)、13例(13/22,59.09%)发生缩小;产后3个月B超复查的27例患者中,靶肌瘤与孕前、孕早中期相比,分别有12例(12/27,44.44%)、18例(18/27,66.67%)靶肌瘤缩小。123例HIFU术后妊娠者中,成功分娩84例、正在妊娠18例、人工流产4例,自然流产17例,成功分娩和自然流产患者术前妊娠丢失史、年龄、肌瘤数量、孕期肌瘤增大发生率差异有统计学意义(P均<0.05),孕期靶肌瘤增大值差异无统计学意义(P>0.05)。结论子宫肌瘤超声消融后妊娠,部分靶肌瘤在孕早中期呈暂时增大,但仍小于HIFU术前靶肌瘤最大径;妊娠晚期靶肌瘤较妊娠早中期无明显变化,产后靶肌瘤呈逐渐缩小趋势。HIFU术后妊娠,孕期靶肌瘤增长程度对妊娠结局无不良影响。Objective To explore the effect of pregnancy on treated target fibroids and pregnancy outcome after high in- tensity focused ultrasound （HIFU） ablation for uterine myoma. Methods Totally 123 pregnant women after HIFU treat- ment of uterine fibriods were selected. Information of patients, imaging features of uterine fibroids, and the outcome of the cured target fibroids during pregnancy and delivery were analyzed. Results The median follow-up time was three years. Compared with pre-pregnancy, there were 60 cases （60/123, 48.78%） with target fibriods increasing in size during the early and middle pregnancy period. The average increase diameter were （2.1-1.6）cm. In all of the 22 cases who under- went myomectomy during cesarean delivery, there were 3 cases （3/22, 13.63%） with shrinkage of target fibroids com- pared with pre-pregnancy, and 13 cases （13/22, 59.09%） with shrinkage compared with early and middle pregnancy. And there were 12 cases （12/27, 44. 44%） and 18 cases （18/27, 66. 67%） with shrinkage of target fibriods among 27 women who underwent ultrasound check three months after delivery. Among the 123 pregnant women, 84 cases delivered success- fully, 18 cases were in pregnancy, 4 cases underwent abortion operation, 17 cases were spontaneous abortion. The preg nancy loss history, age, number of fibroids and target fibroids increase rate had statistically significant differences between delivery and abortion patients （all P〈0.05）, but the average increased diameter of target fibroids during pregnancy had no statistically difference （P〉0.05）. Conclusion Part of the target fibroids have a temporary increase trend during early and mid-pregnancy period, but still are smaller than the maximum diameter of myoma before HIFU, and has no obvious change in the late pregnancy. The fibroids even has a gradually shrink trend at postpartum. The growth degree of target fibroids during pregnancy after HIFU has no adverse effect on pregnancy outcome.

关 键 词：子宫肿瘤 肌瘤 妊娠结局 高强度聚焦超声消融术 

分 类 号：R445.1[医药卫生—影像医学与核医学] R737.33[医药卫生—诊断学]