高强度聚焦超声治疗≥10 cm巨大子宫肌瘤的安全性、有效性及转归研究  

Outcome study of high-intensity focused ultrasound in the treatment of giant uterine fibroids larger than or equal to 10 cm

作　　者：邓勇斌[1] 陈锦云[1] 邹敏 陈骊 汪炼 管楚丽 王智彪[1] Deng Yongbin;Chen Jinyun;Zou Min;Chen Li;Wang Lian;Guan Chuli;Wang Zhibiao(College of Biomedical Engineering,Chongqing Medical University,Chongqing 400016;Department of Gynecology,Chongqing HIFU Hospital,Chongqing 401147,P.R.China)

机构地区：[1]重庆医科大学超声医学工程国家重点实验室,生物医学工程学院,重庆400016 [2]重庆海扶医院妇科,401147

出　　处：《中国计划生育和妇产科》2022年第2期94-98,共5页Chinese Journal of Family Planning & Gynecotokology

摘　　要：目的探讨高强度聚焦超声(high intensity focused ultrasound,HIFU)治疗≥10 cm子宫肌瘤的安全有效性,随访其转归,为巨大子宫肌瘤的临床治疗提供新方案。方法选取2011年3月至2018年12月在重庆医科大学附属第一医院重庆海扶医院就诊的子宫肌瘤最大直径≥10 cm患者149例,在镇静、镇痛下行HIFU治疗。治疗后随访期为24个月。治疗后评价靶肌瘤体积消融率。治疗后3、6、12、18、24个月时,行盆腔增强MRI检查,评价子宫及靶肌瘤体积缩小率。随访临床症状改善情况及再干预情况;依照国际介入放射治疗学会(Society of Interventional Radiotherapy,SIR)标准评价治疗相关的不良反应。结果①安全性:治疗准备及治疗过程中无不良事件发生,治疗后2 h均可以正常活动。SIR标准中重要不良反应(SIR C—D级)事件1例:为黏膜下肌瘤治疗后子宫收缩,腹痛明显,经过宫腔镜处理后顺利拿出黏膜下肌瘤,无D级,严重不良反应(SIR E—F级)的发生率为0;一般不良反应(SIR A~B级)包括下腹部、骶尾部疼痛,下肢酸胀痛及阴道分泌异常等,一般无需治疗,最高发生率为11%。②有效性:治疗后1个月内,靶肌瘤体积消融率平均为(79±18)%;子宫体积在治疗后3、6、12、18、24月时,体积缩小分别为26%、28%、30%、41%、42%,肌瘤于HIFU治疗后3、6、12、18、24个月时,靶肌瘤平均体积分别缩小了37%、48%、52%、59%、68%,与治疗前比较,肌瘤明显缩小,差异均有统计学意义(P<0.01);治疗后3、6、12月,临床症状逐渐改善;③再干预治疗:26例在2年随访过程中进行了进一步的临床干预,总干预率为17.4%。其中12例进行了2次HIFU治疗,14例于术后2年内进行了手术治疗,手术再干预率为9.4%。结论HIFU用于治疗巨大子宫肌瘤是安全、有效的,远期随访中,手术再干预率不到10%,因此,HIFU治疗可以用于巨大子宫肌瘤的治疗,有效改善临床症状,大部分患者可避免切除子宫。Objective To investigate the safety and effectiveness of high-intensity focused ultrasound(HIFU)in the treatmentof uterine fibroids≥10 cm.Methods From March 2011 to December 2018,149 patients with uterine fibroids≥10 cm in Chongqing Haifu Hospital,the First Affiliated Hospital of Chongqing Medical University were selected and treated with HIFU under sedation and analgesia.The follow-up period after treatment was 24 months.The volume ablation rate of target fibroids was evaluated after treatment.At 3,6,12,18,and 24 months after treatment,pelvic enhanced MRI was performed to evaluate the uterine and target fibroid volume reduction rates.Follow-up of clinical symptoms improvement and re-intervention;treatment-related adverse reactions were evaluated according to the International Society of Interventional Radiotherapy(SIR)standards.Results①Safety:No adverse events occurred during treatment preparation and treatment,and normal activities were available 2 hours after treatment.One case of important adverse reaction(SIR C-D)event in SIR standard:uterine contraction after abdominal submucosal fibroids treatment,abdominal pain was obvious,and submucosal fibroids were successfully taken out after hysteroscopy,no grade D,serious adverse The incidence of reactions(SIR E-F grade)was 0;general adverse reactions(SIR A-B grade)included lower abdomen,palate tail pain,lower extremity soreness,vaginal secretion abnormalities,etc.,generally without treatment,the highest incidence rate was 11%.②Effectiveness:within 1 month after treatment,the target fibroid volume ablation rate was(79±18)%on average;the uterine volume decreased by 26%,28%,30%,41%and 42%respectively at 3,6,12,18 and 24 months after treatment,the average volume of target fibroids was reduced by 37%,48%,52%,59%and 68%at 3,6,12,18,and 24 months after HIFU treatment.Compared with before treatment,fibroids were significantly reduced,the differences were statistically significant(P<0.01);Clinical symptoms gradually improved in 3,6,and 12 after treatment;③Re-inte

关 键 词：巨大子宫肌瘤 高强度聚焦超声消融 安全性 有效性 转归 

分 类 号：R737.33[医药卫生—肿瘤]