超声造影增强超声在高强度聚焦超声消融治疗腹壁子宫内膜异位症中的安全性：一项回顾性研究。
The safety of echo contrast-enhanced ultrasound in high-intensity focused ultrasound ablation for abdominal wall endometriosis: a retrospective study.
作者信息
Wang Sha, Li Bo-Han, Wang Jin-Juan, Guo Ying-Shu, Cheng Jiu-Mei, Ye Hong, Zang Chun-Yi, Zhang Ying, Duan Hua, Zhang Xiao-Ying
机构信息
Department of Gynecologic Minimally Invasive Center, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing, China.
出版信息
Quant Imaging Med Surg. 2021 May;11(5):1751-1762. doi: 10.21037/qims-20-622.
BACKGROUND
We aimed to investigate the efficacy and safety of echo contrast-enhanced ultrasound (CEUS) during high-intensity focused ultrasound (HIFU) ablation therapy for abdominal wall endometriosis (AWE).
METHODS
A total of 67 patients with AWE were treated with HIFU ablation, and their demographic characteristics were retrospectively analysed. Blood perfusion of the focal lesion was assessed before the operation, during ablation and after the operation with the use of an ultrasound contrast agent, and the effect of the ultrasound contrast agent on treatment was assessed over a 1-year follow-up period. The degree of symptom relief and adverse effects were evaluated after HIFU ablation.
RESULTS
Eighty-two lesions were ablated in 67 patients. CEUS showed that all lesions were successfully ablated with HIFU. The shrinkage ratio of the lesions significantly increased over the follow-up period. Intermittent pain disappeared at 1 month after the operation, and the patients' pain scores significantly decreased at the 1-year follow-up. The mean [± standard deviation (SD)] lesion volume was 7.64±8.95 cm on B-mode ultrasound. The post-HIFU non-perfused volume was 18.34±24.08 cm, and the rate of massive changes on greyscale imaging was 96.16%±5.44% at 12 months. During the procedure, the main complications were a prickling sensation and tenderness in the treatment area and/or a transient "hot" sensation on the skin. After the procedure, there was no obvious discomfort except for pain. Two patients developed an approximately 1-cm area of skin that exhibited a waxy appearance. Seven patients had haematuria. No severe complications were observed.
CONCLUSIONS
Ultrasound contrast agents are effective and safe for evaluating the effect of HIFU ablation on AWE, and this approach provides significant guidance and evaluation benefits for the use of HIFU treatment for AWE without obvious side effects.
背景
我们旨在研究超声造影增强超声（CEUS）在高强度聚焦超声（HIFU）消融治疗腹壁子宫内膜异位症（AWE）中的有效性和安全性。
方法
对67例AWE患者进行HIFU消融治疗，并对其人口统计学特征进行回顾性分析。使用超声造影剂在术前、消融过程中和术后评估病灶的血流灌注情况，并在1年随访期内评估超声造影剂对治疗的影响。HIFU消融术后评估症状缓解程度和不良反应。
结果
67例患者共消融82个病灶。CEUS显示所有病灶均通过HIFU成功消融。随访期间病灶缩小率显著增加。间歇性疼痛在术后1个月消失，1年随访时患者疼痛评分显著降低。B超下病灶平均体积为7.64±8.95 cm。HIFU术后无灌注体积为18.34±24.08 cm，12个月时灰度成像上的大面积变化率为96.16%±5.44%。术中主要并发症为治疗区域有刺痛感和压痛及/或皮肤短暂“热”感。术后除疼痛外无明显不适。2例患者出现约1 cm大小的皮肤蜡样外观区域。7例患者出现血尿。未观察到严重并发症。
结论
超声造影剂在评估HIFU消融治疗AWE的效果方面有效且安全，该方法为HIFU治疗AWE提供了显著的指导和评估益处，且无明显副作用。
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