超声引导高强度聚焦超声消融治疗弥漫性子宫腺肌病的安全性：一项回顾性队列研究。
Safety of ultrasound-guided high-intensity focused ultrasound ablation for diffuse adenomyosis: A retrospective cohort study.
机构信息
The State Key Laboratory of Ultrasound Engineering in Medicine Co-Founded by Chongqing and the Ministry of Science and Technology, Chongqing Key Laboratory of Biomedical Engineering, College of Biomedical Engineering, Chongqing Medical University, Chongqing Collaborative Innovation Center for Minimally-invasive and Noninvasive Medicine, Chongqing 400016, China.
The State Key Laboratory of Ultrasound Engineering in Medicine Co-Founded by Chongqing and the Ministry of Science and Technology, Chongqing Key Laboratory of Biomedical Engineering, College of Biomedical Engineering, Chongqing Medical University, Chongqing Collaborative Innovation Center for Minimally-invasive and Noninvasive Medicine, Chongqing 400016, China; Clinical Center for Tumor Therapy, The 2nd Hospital, Chongqing Medical University, 76 Linjiang Road, Chongqing 400010, China.
出版信息
Ultrason Sonochem. 2017 May;36:139-145. doi: 10.1016/j.ultsonch.2016.11.022. Epub 2016 Nov 18.
OBJECTIVES
To evaluate the safety of ultrasound-guided high-intensity focused ultrasound (HIFU) ablation for patients with diffuse adenomyosis.
METHODS
This was a retrospective cohort study. The data was collected from 417 symptomatic adenomyosis patients who underwent ultrasound-guided HIFU between January 2012 and December 2015 at 1st Affiliated Hospital of Chongqing Medical University, Chongqing, China. Among them were 260 patients with diffuse adenomyosis (Group D) and 157 patients with focal adenomyosis (Group F). All patients underwent contrast-enhanced magnetic resonance imaging (MRI) one week before and the day after HIFU treatment. Successful treatment with HIFU was measured by the non-perfused volume ratio (NPVR). Intraprocedural and postprocedural adverse effects and complications were recorded to assess the safety of the procedure. Patients were followed-up for three months post-treatment. Complications were given a grade A through F according to the SIR Standards.
RESULTS
All patients successfully completed the procedure, non-perfused regions appeared in 415 (99.5%) patients. The non-perfused volume ratio (NPVR) of Group D was significantly lower than that of Group F (P<0.05). During the procedure, the odds ratio of skin-burning pain was 1.7 (OR=1.617, 95% CI: 1.103-2.532), when comparing Group D with Group F, while the odds ratio of inguinal pain was equal to 2.0 (OR=2.038, 95% CI: 1.161-3.580), when Group F was compared to Group D. 97 patients (23.3%) received nominal therapy due to complications ([Society of interventional radiology, SIR]-B grade), among them, there were 62 cases (23.8%) in Group D and 35 cases (22.3%) in Group F. No significant difference was found between the two groups (P>0.05) and neither of the reported complications of SIR-C-SIR-F occurred within the two groups.
CONCLUSIONS
Based on our results, ultrasound-guided HIFU is safe for the treatment of diffuse adenomyosis, and controlling the ablation zone is crucial to ensure patients' safety.
目的
评估超声引导高强度聚焦超声（HIFU）消融治疗弥漫性子宫腺肌病患者的安全性。
方法
这是一项回顾性队列研究。研究数据来自于 2012 年 1 月至 2015 年 12 月在重庆医科大学第一附属医院接受超声引导 HIFU 治疗的 417 例有症状的子宫腺肌病患者，其中 260 例为弥漫性子宫腺肌病（D 组），157 例为局限性子宫腺肌病（F 组）。所有患者均在 HIFU 治疗前一周和治疗后一天进行对比增强磁共振成像（MRI）检查。通过无灌注体积比（NPVR）评估 HIFU 治疗的成功。记录术中及术后不良反应和并发症，以评估该操作的安全性。患者在治疗后三个月进行随访。根据 SIR 标准，并发症分为 A 至 F 级。
结果
所有患者均成功完成了手术，415 例（99.5%）患者出现无灌注区。D 组的 NPVR 明显低于 F 组（P<0.05）。在手术过程中，与 F 组相比，D 组皮肤灼伤疼痛的比值比（OR）为 1.7（OR=1.617，95%CI：1.103-2.532），而腹股沟疼痛的比值比则相等为 2.0（OR=2.038，95%CI：1.161-3.580），当 F 组与 D 组比较时。由于并发症（SIR-B 级），97 例（23.3%）患者接受了名义治疗，其中 D 组 62 例（23.8%），F 组 35 例（22.3%）。两组之间无显著性差异（P>0.05），两组均未发生 SIR-C-SIR-F 级的报告并发症。
结论
根据我们的结果，超声引导 HIFU 治疗弥漫性子宫腺肌病是安全的，控制消融区域对于确保患者安全至关重要。
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