Ren Xiao-Long, Zhou Xiao-Dong, Zhang Jun, He Guang-Bin, Han Zeng-Hui, Zheng Min-Juan, Li Li, Yu Ming, Wang Lei
Department of Ultrasonography, Xijing Hospital, Fourth Military Medical University, 17 W Changle Rd, Xi'an, Shaanxi 710032, China.
J Ultrasound Med. 2007 Feb;26(2):201-12. doi: 10.7863/jum.2007.26.2.201.
The purpose of this study was to evaluate the therapeutic efficacy of high-intensity focused ultrasound (HIFU) in the treatment of uterine fibroids by using imaging and histopathologic examination.
From May 2004 to June 2005, 119 consecutive patients with 187 uterine fibroids were treated with HIFU. Sixty-two fibroids received ultrasonographically guided needle puncture biopsy 1 week before and after HIFU treatment, respectively, to confirm the diagnosis and to assess the early therapeutic efficacy. Hematoxylin-eosin staining and electron microscopy were performed to characterize more subtle phenotypic changes to determine treatment success. Immediate therapeutic effects were assessed at follow-up with Doppler ultrasonography and computed tomography or magnetic resonance imaging. All patients were followed for 6 to 12 months to observe long-term therapeutic effects. Fibroid mean diameters, volumes, and reduction rates 1, 3, 6, and 12 months after HIFU treatment were calculated and compared with 1-way analysis of variance and Student-Newman-Keuls tests.
No severe complications were observed after HIFU ablation. Fifty-one (82.3%) of 62 biopsy specimens revealed obvious signs of necrosis under light microscopy, and more subtle changes in cellular structure that indicated nonviability could be found in 60 specimens (96.8%) under electron microscopy. However, viable cells still could be found in 16 specimens (25.8%). Follow-up images showed absence or reduction of blood supply in the lesions after HIFU ablation. Median reductions in tumor size as a percentage of initial tumor volume at 1, 3, 6, and 12 months after HIFU treatment were 21.2%, 29.6%, 44.8%, and 48.7%, respectively.
Imaging and histopathologic evidence directly validate HIFU ablation as an effective treatment of uterine fibroids.
本研究旨在通过影像学和组织病理学检查评估高强度聚焦超声（HIFU）治疗子宫肌瘤的疗效。
2004年5月至2005年6月，119例连续患者的187个子宫肌瘤接受了HIFU治疗。62个肌瘤在HIFU治疗前后分别接受超声引导下穿刺活检，以确诊并评估早期治疗效果。进行苏木精-伊红染色和电子显微镜检查以表征更细微的表型变化，从而确定治疗是否成功。随访时通过多普勒超声、计算机断层扫描或磁共振成像评估即时治疗效果。所有患者均随访6至12个月以观察长期治疗效果。计算HIFU治疗后1、3、6和12个月肌瘤的平均直径、体积及缩小率，并采用单因素方差分析和Student-Newman-Keuls检验进行比较。
HIFU消融后未观察到严重并发症。62个活检标本中有51个（82.3%）在光学显微镜下显示出明显的坏死迹象，在电子显微镜下60个标本（96.8%）可发现表明无活力的更细微细胞结构变化。然而，16个标本（25.8%）中仍可发现活细胞。随访图像显示HIFU消融后病变处血液供应缺失或减少。HIFU治疗后1、3、6和12个月，肿瘤大小相对于初始肿瘤体积的中位数缩小百分比分别为21.2%、29.6%、44.8%和48.7%。
影像学和组织病理学证据直接证实HIFU消融是治疗子宫肌瘤的有效方法。
