超声引导经皮穿刺聚桂醇硬化治疗症状性子宫肌瘤的临床应用  

Clinical application of ultrasound-guided percutaneous lauromacrogol sclerotherapy for symptomatic uterine fibroids

作　　者：吕祝英 黄品同[1] 雷志锴[2] 楼军[2] 孔凡雷 陈龙 Lyu Zhuying;Huang Pintong;Lei Zhikai;Lou Jun;Kong Fanlei;Chen Long(Department of Ultrasonography,The Second Affiliated Hospital of Zhejiang University School of Medicine,Hangzhou 310009,China;Department of Ultrasonography,Hangzhou Cancer Hospital,Hangzhou 310002,China;Department of Ultrasonography,Affiliated Hangzhou First People's Hospital,Zhejiang University School of Medicine,Hangzhou 310006,China)

机构地区：[1]浙江大学医学院附属第二医院超声科,杭州310009 [2]杭州市肿瘤医院超声科,310002 [3]浙江大学医学院附属杭州市第一人民医院超声科,310006

出　　处：《中华医学超声杂志（电子版）》2021年第10期991-997,共7页Chinese Journal of Medical Ultrasound(Electronic Edition)

摘　　要：目的探讨超声引导下经皮穿刺聚桂醇硬化治疗症状性子宫肌瘤的临床应用。方法选取杭州市肿瘤医院2017年1月至2019年6月收治的症状性子宫肌瘤患者63例,所有患者均接受超声引导下经皮穿刺聚桂醇硬化治疗。分别于术前及术后1、3、6、12个月行常规超声和超声造影检查,测量瘤体体积,计算瘤体体积缩小率(FSR)并进行症状严重程度评分(SSS)。根据彩色多普勒血流成像分级将子宫肌瘤分为Ⅰ级、Ⅱ级和Ⅲ级供血组,根据子宫肌瘤术前肌瘤最大直径分为直径<3 cm组、3~5 cm组和>5 cm组,根据瘤体类型分为浆膜下肌瘤组、肌壁间肌瘤组和黏膜下肌瘤组,采用秩和检验比较不同瘤体血供组、瘤体大小组及瘤体类型组间的FSR的差异。结果所有患者瘤体硬化治疗术后瘤体体积呈持续缩小趋势,术后1、3、6、12个月的FSR中位数分别为16.98%、51.69%、68.07%、80.83%。术后3、6、12个月SSS中位数较术前(中位数为28.13分)显著下降(中位数分别为21.88分,12.50分,9.38分),差异有统计学意义(Z=-6.990、-9.035、-9.464,P均<0.001)。各亚组间比较结果显示:Ⅲ级血供组、>5 cm组肌瘤及浆膜下肌瘤组的FSR最低,Ⅲ级血供组FSR中位数为78.16%,>5 cm组肌瘤FSR中位数为66.35%,浆膜下肌瘤组FSR中位数为76.97%。术中及术后出现无需治疗的不良反应者19例(30.1%,19/63),无其他严重并发症发生。结论超声引导下经皮穿刺聚桂醇硬化治疗症状性子宫肌瘤创伤小、效果确切、并发症少,但对>5 cm、血供丰富或浆膜下肌瘤疗效欠佳。Objective To investigate the clinical application of ultrasound-guided percutaneous lauromacrogol sclerotherapy for symptomatic uterine fibroids.Methods A total of 63 patients with symptomatic uterine fibroids who were admitted to Hangzhou Cancer Hospital from January 2017 to June 2019 were selected.All patients underwent ultrasound-guided percutaneous lauromacrogol sclerotherapy.Conventional ultrasonography and contrast-enhanced ultrasonography were performed before therapy and 1,3,6,and 12 months after therapy.The volume of the tumor was measured.The fibroid shrinkage rate(FSR)and symptom severity score(SSS)were calculated to evaluate the efficacy.Then,the FSR was compared by tumor blood supply,tumor size,and tumor type.Results The tumor volume in the 63 cases receiving tumor sclerotherapy showed a continuous shrinking trend.The median FSR at 1,3,6,and 12 months after the therapy were 16.98%,51.69%,68.07%,and 80.83%,respectively.The median SSSs at 3,6,and 12 months after therapy(21.88,12.50,and 9.38,respectively)were significantly lower than that before therapy(28.13;Z=-6.990,-9.035,and-9.464,P<0.001 for all).FSR was lowest in the gradeⅢblood supply subgroup,>5 cm myoma subgroup,and subplasma myoma subgroup,with a median FSR of 78.16%,66.35%,and 76.97%,respectively.There were 19(30.1%,19/63)cases with adverse reactions that did not require treatment during and after the therapy,and no other serious complications occurred.Conclusion Ultrasound-guided percutaneous lauromacrogol sclerotherapy for symptomatic uterine fibroids is minimally invasive and effective,and has fewer complications,but it is less effective for fibroids>5 cm,those with rich blood supply,and subplasma fibroids.

关 键 词：子宫肌瘤 聚桂醇 硬化 

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]