邻近骶尾部子宫肌瘤超声消融后周围组织损伤的MRI评价  

MRI Evaluation of Surrounding Tissue Damages After Ultrasonic Ablation of Uterine Fibroids Adjacent to the Sacrococcyx

作　　者：郑安琪 陈锦云[1,2] 肖智博[3] 张蓉 白晋[1] ZHENG Anqi;CHEN Jinyun;XIAO Zhibo;ZHANG Rong;BAI Jin(State Key Laboratory of Ultrasound in Medicine and Engineering,College of Biomedical Engineering,Chongqing Medical University,Chongqing 400016,China;Therapeutic Center of Ultrasound Ablation,the First Affiliated Hospital of Chongqing Medical University,Chongqing 400042,China;不详)

机构地区：[1]超声医学工程国家重点实验室重庆医科大学生物医学工程学院,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 [3]重庆医科大学附属第一医院放射科,重庆400042

出　　处：《中国医学影像学杂志》2021年第5期493-497,502,共6页Chinese Journal of Medical Imaging

摘　　要：目的研究邻近骶尾部子宫肌瘤超声消融术后靶区与非靶区MRI特征及损伤情况。资料与方法回顾性分析接受超声消融的258例子宫肌瘤患者的资料。通过术前及术后MRI特征比较,观察子宫肌瘤靶区消融情况与非靶区损伤情况。结果术后子宫肌瘤体积消融率25%~100%,平均(71±18)%。子宫内膜损伤27例(10.5%),子宫浆肌层损伤30例(11.6%),骶骨损伤83例(32.2%),腹壁损伤22例(8.5%),盆腔积液42例(16.3%)。不同部位子宫肌瘤中,宫底肌瘤子宫内膜损伤发生率最高[20.0%(4/20)],前壁肌瘤盆腔积液发生率最高[29.9%(23/77)],后壁肌瘤骶骨损伤发生率最高[43.2%(35/81)]。不同类型肌瘤中,浆膜下肌瘤子宫浆肌层损伤发生率[28.6%(16/56)]高于肌壁间[7.8%(14/180)]和黏膜下肌瘤[0(0/22)],差异有统计学意义(P均<0.05);黏膜下肌瘤子宫内膜损伤发生率[27.3%(6/22)]高于肌壁间[9.4%(17/180)]和浆膜下肌瘤[7.1%(4/56)],差异有统计学意义(P均<0.05)。结论邻近骶尾部子宫肌瘤可以获得成功的超声消融,但会发生子宫内膜、子宫浆肌层、骶骨、腹壁损伤及盆腔积液,其中骶骨损伤发生率最高。Purpose To evaluate the MRI characteristics and damages of the target and non-target areas after ultrasonic ablation of uterine fibroids in the adjacent region of sacrococcyx.Materials and Methods A total of 258 patients with uterine fibroids who underwent ultrasound ablation were retrospectively analyzed.Preoperative and postoperative MRI imaging features were obtained and compared to observe the ultrasonic ablation of uterine fibroids and surrounding tissue damages.Results Postoperative volume ablation rate of uterine fibroids ranged from 25%to 100%,averaging(71±18)%.There were 27 cases(10.5%)of endometrial injury,30 cases(11.6%)of seromuscular-layer injury,83 cases(32.2%)of sacrum injury,22 cases(8.5%)of abdominal wall injury,and 42 cases(16.3%)of pelvic effusion.Among the different locations of uterine fibroids,the highest incidence of endometrial injury[20.0%(4/20)]was showed in the fundus uterine fibroids;the highest incidence of pelvic effusion[29.9%(23/77)]was presented in the anterior wall uterine fibroids;and the highest incidence of sacrum injury[43.2%(35/81)]was displayed in the posterior wall uterine fibroids.Among different types of uterine fibroids,the incidence of uterine seromuscular-layer injury in subserosal fibroids[28.6%(16/56)]was significantly higher than that in intramural[7.8%(14/180)]and submucosal uterine fibroids[0(0/22),P<0.05];and the incidence of endometrial injury in submucosal fibroids[27.3%(6/22)]was significantly higher than that in intramural[9.4%(17/180)]and subserosal uterine fibroids[7.1%(4/56),P<0.05].Conclusion Uterine fibroids adjacent to the sacrococcygeal region can be successfully ablated by ultrasound,however,endometrial injury,seromuscular-layer injury,sacrum injury,abdominal wall injury and pelvic effusion could be commonly found,with the highest incidence in the sacrum injury。

关 键 词：子宫肿瘤 平滑肌瘤 超声 高强聚焦 经直肠 磁共振成像 损伤 

分 类 号：R730.4[医药卫生—肿瘤] R711.74[医药卫生—临床医学]