聚焦超声消融治疗对Ⅱ~Ⅲ型(FIGO分型)子宫肌瘤快速降型的初步临床研究  

Preliminary Clinical Study of Focused Ultrasound Ablation Therapy on Rapid Type Reduction of FIGO Types Ⅱ-Ⅲ Uterine Fibroids

作　　者：雷婷婷 何玉春[3] 郭旭 陈雪莲[3] 冉峰 王雅溱 何佳 Lei Tingting;He Yuchun;Guo Xu;Chen Xuelian;Ran Feng;Wang Yaqin;He Jia(State Key Laboratory of Ultrasound in Medicine and Engineering,College of Biomedical Engineering,Chongqing Medical University,Chongqing 400016,China;Chongqing Key Labo-ratory of Biomedical Engineering,Chongqing Medical University,Chongqing 400016,China;Department of Obstetrics and Gynaecology,Suining Municipal Hospital of Traditional Chi-nese Medicine·Suining Maternal and Child Health Hospital,Suining 629000,Sichuan,China)

机构地区：[1]重庆医科大学生物医学工程学院超声医学与工程国家重点实验室,重庆400016 [2]重庆医科大学生物医学工程重点实验室,重庆400016 [3]遂宁市中医院/遂宁市妇幼保健院妇产科,四川遂宁629000

出　　处：《肿瘤预防与治疗》2021年第8期743-751,共9页Journal of Cancer Control And Treatment

基　　金：四川省中医药管理局科学技术研究专项课题(编号:2020LC0220)。

摘　　要：目的:探讨聚焦超声消融(focused ultrasound ablation,FUA)治疗对Ⅱ~Ⅲ型子宫肌瘤的快速降型作用。方法:2020年8月至2021年3月,根据盆腔核磁共振及宫腔镜检查联合诊断为Ⅱ~Ⅲ型子宫肌瘤(肌瘤最大直径≥4 cm)的8例在遂宁市中医院接受FUA联合宫腔镜治疗的患者纳入本研究,统计FUA术前术后肌瘤分型及降型情况,宫腔镜下子宫肌瘤切除术(transcervical resection of myoma,TCRM)手术时间、肌瘤病灶切除率、术前术后血红蛋白改变、手术并发症、肌瘤相关症状改善等。结果:8例患者共接受10次FUA治疗(其中2例多发性子宫肌瘤患者接受2次治疗),FUA辐照时间中位数为599(范围:180~1575)s;治疗时间中位数83(范围:23~136)min;辐照剂量中位数239600(范围:62400~342000)J;治疗强度中位数470(范围:328~695)s/h。FUA术后即刻超声造影显示肌瘤平均消融率为83.70%(范围:63.4%~96.88%)。术中患者出现不同程度的治疗区疼痛、下腹部疼痛、腰骶部疼痛、皮肤烫等。疼痛评分(视觉评分量表)1~3分,停止治疗症状均可明显缓解,术中术后无严重并发症出现。患者于FUA术后1~4天行超声监护下宫腔镜检查+TCRM,其中14个肌瘤均实现降型,7个Ⅱ型肌瘤均降为Ⅰ型,5个Ⅲ型肌瘤均降型为Ⅱ型肌瘤,两例多发性子宫肌瘤患者还存在Ⅰ型肌瘤降型为0型肌瘤的情况。宫腔镜手术中位时间23(范围:20~53)min,12个肌瘤完整切除,其中2例为多发性子宫肌瘤患者,因病灶大,FUA后Ⅱ型肌瘤降型为Ⅰ型肌瘤,第一个疗程中TCRM切除60%病灶,术后1月再次行FUA+超声引导下宫腔镜检查+TCRM,完整切除病灶。宫腔镜下电切肌瘤组织出血量少,术前患者血红蛋白(hemoglobin,HGB)中位数109 g/L,术后HGB中位数98 g/L。术中及术后无患者出现严重并发症。结论:FUA使子宫肌瘤组织凝固性坏死,疗效确切,同时发现FUA对贴近子宫内膜的Ⅱ~Ⅲ型的肌瘤有快速降型作用,对这部分不适合采取Objective: To explore the effect the focused ultrasound ablation(FUA) therapy exerts on the rapid type reduction of types Ⅱ-Ⅲ uterine fibroids. Methods: This study analyzed data on types of fibroid before and after FUA, type reduction, operation time of transcervical resection of myoma(TCRM), resection rates of fibroids, changes in hemoglobin before and after surgery, surgical complications and improvements in myoma-related symptoms in 8 patients who were diagnosed as type Ⅱ-Ⅲ uterine fibroids(maximum diameter ≥4 cm) through both pelvic MRI and hysteroscopy and accepted the combined treatment of FUA and hysteroscopy from August 2020 to March 2021. Results: The 8 patients accepted 10 times of FUA(including two patients with multiple uterine fibroids accepted treatment twice), with the median FUA time of 599 seconds(180~1,575 seconds), the median treatment time of 83 minutes(23~136 minutes), the median radiation dose of 239,600 J(62,400~342,000 J), and the median treatment intensity of 470 s/h(328~695 s/h). Immediate contrast-enhanced ultrasound after FUA showed that the average success rate of ablation was 83.70%(63.4%~96.88%). During the operation, patients experienced varying degrees of lower abdomen pain, pain in the treatment area, lumbosacral pain and skin burning. Scores of pain(Visual Analogue Scale) ranged from 1 to 3 points, and the symptom was significantly relieved after the treatment was ceased, without serious complications during and after the operation. The patinets underwent ultrasound-guided hysteroscopy and TCRM 1~4 days after FUA.14 cases were alleviated, including 7 type II fibroids reduced to type I;5 type III fibroids reduced to type II;and 2 type I multiple uterine fibroids reduced to type 0.12 fibroids were completely removed by hysteroscopic surgery, with the median operation time of 23 minutes(20~53 minutes). For the 2 patients with multiple uterine fibroids who had large lesions, type II fibroids were reduced to type I after FUA, 60% of the lesions were then removed by TCRM in

关 键 词：子宫肌瘤 聚焦超声消融治疗 宫腔镜手术 

分 类 号：R730.59[医药卫生—肿瘤] R737.33[医药卫生—临床医学]