摘要
目的探讨超声消融子宫腺肌病的有效性和安全性。方法对重庆医科大学附属第一医院2007年3月至2008年9月期间78例以痛经为主伴有或不伴有经量增多的子宫腺肌病患者行超声消融治疗,评价患者对治疗的耐受性,定期随访治疗后症状变化,记录治疗后6个月内不良反应发生情况,增强MRI评价治疗前后病灶凝固性坏死情况。结果78例患者中疼痛评分4分以下者占84.6%,其中1例因血压升高不能缓解而终止治疗;具有完整随访资料的患者69例,随访时间(11.9±6.4)个月。治疗前后月经量评分和痛经评分降低,差异具有显著性(P<0.05);62例痛经症状得到不同程度缓解,总有效率89.9%;69例患者中22例(32%)发生不良反应,其中4例发生2种以上。27例次数不良反应中23例(85.1%)为SIRA类;4例(14.8%)SIRB类不良反应对症处理后均恢复;全部病例均无严重的不良事件发生,亦无住院时间延长或再次入院。60例增强MRI可见无灌注区域,凝固性坏死发生率为87.0%,无灌注区大小和病灶部位与不良反应发生均无相关性(P>0.05)。结论超声消融是一种安全有效的治疗方式,可成为子宫腺肌病可供选择的一种新型无创治疗方式。
Objective To identify the safety and efficacy of high intensity focused ultrasound （HIFU） ablation in treatment of adenomyosis.Methods Ultrasound ablation （Frequency 0.8 MHz,focal region 1.5 mm×1.5 mm×10 mm,circulating degassed water as acoustic couplant 3×10-6 g/L） was performed in 78 adenomyosis patients suffering from dysmenorrhea with or without increase of menstrual quantity in our department from March 2007 to October 2008.All patients were surveyed regarding their pain levels ranging from 0 to 10 after the treatment immediately evaluated by numeric rating scale （NRS）.Enhanced magnetic resonance imaging （MRI） was performed in 0 to 3 months after the treatment according to imaging parameters pre-treatment to assess coagulative necrosis.Clinical evaluation using a standardized questionnaire was carried out at regular intervals after ultrasound ablation to assess patient outcome.Each complication was categorized and graded as to severity and outcome using the complication classification developed by the Society of Cardiovascular and Interventional Radiology （SIR）.Results In all 78 patients,84.6% patients tolerated the treatment procedure well with 0 to 4 pain scores.Only one ablation was terminated because the patient had elevated blood pressure steadily.The number of the cases completely follow-up was 69,and the mean follow-up time was （11.9±6.4） months.The scores of menorrhea and dysmenorrhea after the treatment were lower than those pre-treatment significantly （P0.05）.Clinical effectiveness was observed in 62 （89.9%） of the 69 women with variety relief of dysmenorrheal.Complications were observed in 22 （87.0%） of the 69 women,more than 2 events occurred in 4 women.Twenty-three （85.1%）of 27 events are SIR A.Four （14.8%） women who experienced SIR B events recovered after symptomatic therapy.There was no serious complication,including death and major permanent injuries.And there was no prolonged hospitalization and readmission.Coagulative necrosis was observed in 60 （87.0%） of the 69 women with non-perfusion region by enhanced MRI.There was no correlation of non-perfusion region and lesion location with complication （P0.05）.Conclusion HIFU ablation has safety and efficacy for adenomyosis treatment.Ultrasound ablation may be an option of new non-invasive treatment for symptomatic adenomyosis.
出处
《第三军医大学学报》
CAS
CSCD
北大核心
2010年第10期1079-1082,共4页
Journal of Third Military Medical University
基金
国家自然科学基金重点项目(30830040)
国家青年科学基金(30901234)~~
关键词
子宫腺肌病
超声消融
有效性
安全性
adenomyosis
ultrasound ablation
high intensity focused ultrasound
safety
efficacy
