聚焦超声消融治疗子宫黏膜下肌瘤的疗效及安全性

[Efficacy and safety of focused ultrasound ablation in treatment of submucosal uterine fibroids].

作者信息

Wang Ting, Wang Wei, Chen Wen-zhi, Wang Yue-xiang, Ye Hui-yi, Tang Jie

机构信息

Department of Ultrasound, Chinese People's Liberation Army General Hospital, Beijing 100853, China.

出版信息

Zhonghua Fu Chan Ke Za Zhi. 2011 Jun;46(6):407-11.

PMID:21781578

Abstract

OBJECTIVE

To evaluate the efficacy and safety of focused ultrasound ablation in the treatment of submucosal fibroids which broke into uterine cavity less than 50%.

METHODS

From Oct. 2006 to Sept. 2009, 66 patients with 69 submucosal fibroids broke into uterine cavity less than 50% diagnosed by MRI in Chinese People's Liberation Army General Hospital were enrolled in this study. They were treated by ultrasound-guided focused ultrasound ablation in the outpatient department, which using the contrast enhanced ultrasonography to assess the efficacy after ablation immediately, to measure reduction of fibroids volume and record adverse effect before and after ultrasound ablation. At 3, 6, 12 and 24 months after treatment, ablation outcome and fibroids volumes were evaluated by contrast ultrasound. The changes of clinical symptom were evaluated by the symptom severity score (SSS) of the uterine fibroid quality-of-life instrument (UFS-QOL).

RESULTS

The average volume of fibroids in 66 patients with 68 submucosal fibroids were (151 ± 134) cm(3) before treatment and (114 ± 104) cm(3) no enhanced regional after treatment. The ablation rate of target fibroids was (77 ± 16)%. All patients completed this treatment successfully, they were followed up for 6 - 44 months, the median follow-up time was 24 months. No serious complication was observed. However, there were 52% (34/66) patients presented vaginal discharge after ablation, it disappeared gradually after 3 to 4 menstrual cycles. The SSS and the menstrual period symptom scores were significantly lower than that before ablation at the follow-up of 3, 6, 12 and 24 months, the rates were 20.9%, 38.0%, 45.1%, 47.1% and 42.0%, 63.8%, 64.2%, 68.8%, which all reached statistical difference (P < 0.05). The necrotic fibroids were absorbed gradually, the reduction rates of fibroid volume were 44.7%, 66.0%, 77.7% and 89.8%.

CONCLUSION

It was safe and efficacy that focused ultrasound ablation was used in treatment of submucosal fibroids which broke into the uterine less than 50%.

摘要

目的

评估聚焦超声消融治疗突入宫腔小于50%的黏膜下肌瘤的疗效及安全性。

方法

选取2006年10月至2009年9月在中国人民解放军总医院经磁共振成像（MRI）诊断为突入宫腔小于50%的黏膜下肌瘤患者66例，肌瘤69个。于门诊行超声引导下聚焦超声消融治疗，消融后即刻采用超声造影评估疗效，测量肌瘤体积缩小情况，并记录超声消融前后的不良反应。治疗后3、6、12及24个月，采用超声造影评估消融效果及肌瘤体积变化。采用子宫肌瘤生活质量量表（UFS-QOL）的症状严重程度评分（SSS）评估临床症状变化。

结果

66例患者68个黏膜下肌瘤治疗前平均体积为（151±134）cm³，治疗后无增强区平均体积为（114±104）cm³。目标肌瘤消融率为（77±16）%。所有患者均成功完成治疗，随访6～44个月，中位随访时间为24个月。未观察到严重并发症。然而，52%（34/66）的患者消融后出现阴道分泌物，3～4个月经周期后逐渐消失。随访3、6、12及24个月时，SSS及经期症状评分均显著低于消融前，分别为20.9%、38.0%、45.1%、47.1%和42.0%、63.8%、64.2%、68.8%，差异均有统计学意义（P<0.05）。坏死肌瘤逐渐吸收，肌瘤体积缩小率分别为44.7%、66.0%、77.7%和89.8%。