改良射频消融术治疗子宫肌瘤的临床应用和效果评价

目的应用改良射频消融技术治疗子宫肌瘤,与常规射频消融术比较观察临床效果。方法 142例子宫肌瘤患者共164枚肌瘤,瘤体直径2.0~6.3 cm,用随机数字表法分为常规射频消融术治疗组(常规组)60例,改良射频消融术治疗组(改良组)82例,分别采用射频消融技术及在此基础上增加治疗时间、术后取瘤并局部降温的方法进行治疗。采用三维彩超测量术前及术后1、3、6个月时子宫及肌瘤体积,比较两组患者的子宫及肌瘤缩小率,观察临床治愈率、总有效率和术后并发症发生率。结果常规组、改良组射频消融后1个月子宫缩小率分别为9.54%和10.14%,肌瘤缩小率分别为32.56%和36.59%,差异均无统计学意义(P>0.05)。术后3个月及6个月时两组患者的子宫缩小率分别为32.52%、44.81%和42.51%、60.73%,肌瘤缩小率分别为48.28%、54.44%和61.30%、68.43%,差异均有统计学意义(P<0.05)。术后6个月时常规组、改良组患者的治愈率分别为63.33%(38/60)和78.05%(64/82),差异有统计学意义(P<0.05),总有效率分别为95.00%(57/60)和98.78%(81/82),差异无统计学意义(P>0.05)。术后常见并发症包括下腹疼痛、阴道流血、阴道排液、发热。改良组的并发症发生率为10.98%(9/82),低于常规组的23.33%(14/60),差异有统计学意义(P<0.05)。结论改良射频消融术治疗子宫肌瘤后明显缩小子宫和肌瘤体积,临床效果显著,术后并发症少,可以作为微创治疗子宫肌瘤的主要方法。     

Expulsion of dominant submucosal fibroids after uterine artery embolization

Purpose

Purpose of this study was to evaluate the frequency, probability, and factors associated with expulsion of submucosal fibroids after uterine artery embolization (UAE) in addition to the technical and clinical results at 1-year follow-up.

Materials and methods

We determined the preinterventional volume of each dominant submucosal fibroid using the commonly used ellipsoid formula and a 3D volumetry in the MRI to define a threshold value in milliliters that indicates the probability for a fibroid expulsion. Assessment of fibroid expulsion was done by MRI at 3-month intervals for a year. Assessment of clinical mid term success was achieved by applying questionnaires at 1-year follow-up.

Results

Technical success was observed in all 20 patients (mean age of 41.4 ± 5.6 years; range: 29.2-51.1 years). Two (10%) minor and one (5%) major complications occurred. 10/20 dominant submucosal fibroids were completely expelled during the follow-up. Using 3D MRI volumetry the preinterventional mean volume of the later expelled fibroids was 56.8 ± 57.0 ml (range 2.3-198.0 ml) and the mean volume of non-expelled fibroids was 123.8 ± 147.3 ml (range 24.0-531.8 ml). This difference was statistically significant, but weak (p = 0.0494). Fibroids with a volume equal or less than the threshold value (66.0 ml) were 73% likely to be expelled and fibroids larger than 66.0 ml were 78% likely not to be expelled. All 20 patients demonstrated a significant reduction in the fibroid related symptoms.

Conclusion

In our study the complication rate was low despite increased rates of fibroid expulsion (50%); simultaneously the rate of treatment satisfaction was very high. Patients with a dominant submucosal fibroid under 66.0 ml should be informed about the probability of fibroid expulsion and the accompanying symptoms.     

子宫动脉栓塞治疗子宫黏膜下肌瘤的疗效及安全性

目的 探讨子宫动脉栓塞术(uterine arterial embolization,UAE)治疗子宫黏膜下肌瘤的转归、疗效及安全性.方法 2008年1月至2011年10月收治 74例经超声及宫腔镜检查确诊的子宫黏膜下肌瘤患者,行UAE治疗,并观察术后疗效及安全性.结果 74例患者术后随访12 ～ 24个月,月经量均明显减少,贫血改善.70例患者肌瘤自阴道排出,2例回缩至肌层,2例肌瘤明显缩小.术中、术后不同程度疼痛71例,发热18例,分泌物增多50例,肌瘤排出过程中感染6例,经对症治疗后症状均逐渐消失.3例月经稀少,3例发生子宫性闭经,膀胱损伤1例,14 d治愈.术前、术后激素水平测定差异无统计学意义(P﹥0.05).结论 UAE治疗子宫黏膜下肌瘤疗效显著、微创、安全,但对于有强烈生育要求的患者应慎重选择.     

宫腔镜手术治疗子宫黏膜下肌瘤63例

子宫肌瘤是女性生殖器官最常见的良性肿瘤,在不孕女性中肌瘤更为常见,尤以黏膜下肌瘤为著.肌瘤治疗的方法有非手术治疗及手术治疗,至今为止尚无安全有效、复发率低的非手术治疗方法.随着宫腔镜技术的兴起,近年来应用越来越广泛,其最大的优点是能直视宫腔内的病理生理变化,定位取材[1].目前宫腔镜手术治疗已成为子宫黏膜下肌瘤的首选方式,我院2002年3月～2007年10月共做63例,效果满意.     

Uterine myomas in pregnancy

Pregnancy complications occur in many patients who have uterine myomas. Patients in whom the placenta is implanted near a myoma are more likely to be affected. Early pregnancy bleeding, premature rupture of membranes and postpartum hemorrhage are the problems most frequently seen. Sonographic assessment identifies these patients who are at risk and in whom special precautions are advisable.     

Spontaneous prolapse of pedunculated uterine submucosal leiomyoma: usefulness of broccoli sign on CT and MR imaging

We report the case of a patient who presented with a bulky perineal mass expelled from the introitus. Computed tomography and magnetic resonance (MR) imaging revealed that it was prolapsed submucosal uterine leiomyoma. It is unusual that submucosal leiomyoma is expelled to the perineum, but the MR imaging findings were characteristic and had a "broccoli-like" appearance. Familiarity with this appearance may be helpful in diagnosing prolapsed leiomyoma which is uncommon but has characteristic imaging feature.     

Interface vessels on color/power Doppler US and MRI: a clue to differentiate subserosal uterine myomas from extrauterine tumors

PURPOSE: In subserosal myomas, vessels are often demonstrated between the masses and the uterus. This study was performed to assess the usefulness of demonstrating these vessels in differentiating subserosal myomas from extrauterine tumors on color or power Doppler US (CDUS/PDUS) and MRI. METHOD: This retrospective study included 41 patients with subserosal myomas and 27 patients with solid extrauterine tumors. The incidence and shape of these vessels seen on CDUS/PDUS and MRI were compared in the myoma and extrauterine tumor groups. RESULTS: The interface vessels were demonstrated in 39 of 41 subserosal myomas (18 on CDUS/PDUS, 14 on MRI, 7 on both), whereas they were seen in only 3 of 27 extrauterine tumors (1 on CDUS/PDUS, 2 on MRI). These three extrauterine tumors were ovarian malignancies that directly invaded the uterus. The shapes of these interface vessels were 7 intervening, 12 crossing, and 20 mixed in the myoma group, whereas they were mixed in all three extrauterine tumor groups. The sensitivity/specificity of this finding in differentiating subserosal myomas and extrauterine tumors was 100/92%, 91/91%, and 95/89%, respectively, with CDUS/PDUS, MRI, and either CDUS/PDUS or MRI. CONCLUSION: Observation of the interface vessels between the uterus and juxtauterine masses seems to be a useful clue in differentiating subserosal myomas from extrauterine tumors.     

Incidence and characteristics of uterine leiomyomas with FDG uptake

Objective  Uterine leiomyomas sometimes show focal ¹⁸F-fluorodeoxyglucose (FDG) uptake on positron emission tomography (PET) images that may result in a false-positive diagnosis for malignant lesions. This study was conducted to investigate the incidence and characteristics of uterine leiomyomas that showed FDG uptake. Methods  We reviewed FDG-PET and pelvic magnetic resonance (MR) images of 477 pre-menopausal (pre-MP, age 42.1 ± 7.3 years) and 880 post-MP (age 59.9 ± 6.8 years) healthy women who underwent these tests as parts of cancer screening. Of 1357, 323 underwent annual cancer screening four times, 97 did three times, 191 did twice, and the rest were screened once. Focal FDG uptake (maximal standardized uptake value > 3.0) in the pelvis was localized and characterized on co-registered PET/MR images. Results  Uterine leiomyomas were found in 164 pre-MP and 338 post-MP women. FDG uptake was observed in 18 leiomyomas of 17 of the 164 (10.4%) pre-MP women and in 4 leiomyomas of 4 of the 338 (1.2%) post-MP women. The incidence was significantly higher in pre-MP women than in post-MP women (chi-square, P < 0.001). Of the 22, 13 showed signal intensity equal to or higher than that of the myometrium on T2-weighted MR images, which suggested abundant cellularity, whereas the majority of leiomyomas without FDG uptake showed low signal intensity. Of the 13 women, 12 examined more than twice showed substantial changes in the level of FDG uptake in leiomyomas each year with FDG uptake disappearing or newly appearing. These changes were observed frequently in relation with menopause or menstrual phases. Conclusions  Leiomyomas with focal FDG uptake were seen in both pre-and post-MP women with a higher incidence in pre-MP women. Abundant cellularity and hormonal dependency may explain a part of the mechanisms of FDG uptake in leiomyomas. It is important to know that the level of FDG uptake in leiomyomas can change and newly appearing FDG uptake does not necessarily mean malignant transformation.     

子宫肌瘤磁共振扩散张量成像特征的初步研究

目的：分析子宫肌瘤和正常子宫肌层磁共振扩散张量成像(DTI)的影像特征,探讨 DTI 在评估子宫肌瘤结构的应用价值。方法研究对象为经手术病理证实的44例子宫肌瘤患者,DTI 采用双梯度 GE HDxt 3.0T 和 HD Cardiac 线圈,应用 GE AW4.5工作站进行数据处理。记录子宫肌瘤和正常子宫肌层的表观扩散系数(ADC)、各向异性分数(FA)值、容积比各向异性(VRA)值和 T2-weighted trace 值,绘制扩散张量的纤维示踪图像(DTT)。对比不同感兴趣区(ROI)的成像指标差异。结果正常子宫肌层和子宫肌瘤的 ADC、FA、VRA、T2-weighted trace 平均值分别为(1.65±0.32)×10-9 mm2/s 和(1.21±0.97)×10-9 mm2/s、0.20±0.08和0.28±0.08、0.05±0.05 和0.09±0.07、344.22±66.19和318.97±98.48。正常子宫肌层 ADC 值高于子宫肌瘤(P =0.009)。正常子宫肌层的 FA 和 VRA 低于子宫肌瘤(P =0.000、P =0.005)。2组的 T2-weighted trace 值差异无统计学意义(P =0.174)。DTI 纤维示踪图显示正常子宫肌层和子宫肌瘤的纤维方向、排列和数量存在明显的差异。结论 DTI 能够反映出正常子宫肌层和子宫肌瘤的微观结构差异,有助于提高 MRI 对子宫肌瘤的影像学评估的应用价值。     

Benign submucosal lesions of the stomach and duodenum: imaging characteristics with endoscopic and pathologic correlation

Benign submucosal lesions of the stomach and duodenum are occasionally encountered during endoscopy. But endoscopy has its limitations in the diagnosis and differentiation of these lesions, because submucosal lesions are often difficult to visualize at endoscopy due to minimal change of the overlying mucosa. Furthermore, endoscopic biopsy may not always yield adequate tissue for diagnosis due to the submucosal location of the lesions. For this reason, the role of radiologic imaging is important in the diagnosis of submucosal lesions of the stomach and duodenum. Recent advances in computed tomography (CT) and sonographic technology are helpful in narrowing the differential diagnosis of gastroduodenal submucosal lesions. In contrast to endoscopy and barium studies, CT or ultrasonography (US) provides information about both the gastric wall and the extragastric extent of the disease. Arterial phase contrast enhanced CT enables us to discriminate a mass of submucosal from that of a mucosal origin in the differential diagnosis of gastric or duodenal lesions. Although endoscopic sonography has been considered the better modality in the diagnosis of gastroduodenal submucosal lesions, transabdominal sonography can still be an alternative method to endoscopic sonography in assessing of the origin and character of the submucosal lesions. Some gastroduodenal submucosal lesions have similar radiologic findings that make differentiation difficult. But despite overlaps in radiologic findings, some lesions have characteristic radiologic features that may suggest a specific diagnosis. Knowledge of the differential diagnosis of benign submucosal lesions in the stomach and duodenum may promote correct diagnosis and appropriate treatment.     

高强度聚焦超声刀治疗子宫肌瘤临床研究

目的 探讨高强度超声聚焦刀治疗子宫肌瘤的疗效及安全性.方法 临床诊断的年龄在26～59岁已生育的子宫肌瘤47例患者,实施高强度超声聚焦刀治疗,对比治疗前后患者临床症状改善情况及B超检测肿瘤大小变化.结果 治疗后患者痛经、经量增多等症状明显改善,部分患者出现血尿,对症处理后好转.瘤体体积治疗前(47.6±24.1)cm3,治疗6个月后为(17.7±13.1)cm3,t检验显示治疗前后瘤体体积变化差异有统计学意义(P＜0.05).结论 采用高强度超声聚焦刀治疗子宫肌瘤安全性高且效果显著.     

经内镜黏膜下不同术式治疗贲门周围黏膜下肿瘤疗效分析

目的 探讨经内镜黏膜下肿瘤隧道切除术(STER)、内镜黏膜下剥离术(ESD)治疗贲门周围黏膜下肿瘤的临床疗效.方法 选取北部战区总医院内窥镜科自2016年7月至2020年10月收治的52例接受内镜治疗贲门周围黏膜下肿瘤患者为研究对象.根据不同手术方式将其分为STER组(n=18)与ESD组(n=34).记录并比较两组患...     

内镜黏膜下剥离术治疗上消化道黏膜下病变疗效及安全性

目的探讨内镜黏膜下剥离术（ESD）治疗上消化道黏膜下病变的疗效及安全性。方法消化内镜检查发现上消化道黏膜下病变,经超声内镜确定黏膜下病变的种类及层次,在内镜下行ESD共57例,切除全瘤组织行病理切片明确病变性质。结果所有57例黏膜下病变均成功切除。病理示间质瘤40例（70.1%）,囊肿2例（3.5%）,平滑肌瘤8例（14.0%）,胃黏膜下血管瘤1例（1.8%）,胃异位胰腺5例（8.8%）,胃早癌1例（1.8%）。超声内镜诊断与病理一致率达94.7%（54/57）。结论 ESD是治疗上消化道黏膜下病变较为安全及有效的方法。     

支气管内黏膜下血管瘤一例

患者女,64岁.50 d前出现咳嗽、咯痰、喘息,抗炎治疗后症状略好转,但出现胸痛,深呼吸时疼痛加重,于2009年5月3日来本院就诊.体检:左肺下叶呼吸音减弱.肺功能检查:阻塞性肺通气功能障碍,残气率、气道阻力增加. 纤维支气管镜检查:左主支气管下端可见似带蒂状紫红色肿物完全阻塞管腔,光滑.胸部X线平片:左下肺疑似斑片影.胸部CT检查:左主支气管腔内见软组织密度类圆形结节影,直径1 cm,CT值39 HU,其远端支气管腔内见低密度痰栓,纵隔向左侧移位;增强扫描:左主支气管腔内结节病灶明显强化,静脉期强化幅度最大,CT值131 HU,中心见放射状条形无强化低密度区,冠状面重组时病灶显示更清楚.     

Endoscopically removed giant submucosal lipoma

BACKGROUND: Although uncommon, giant submucosal colon lipomas merit attention as they are often presented with dramatic clinical features such as bleeding, acute bowel obstruction, perforation and sometimes may be mistaken for malignancy. There is a great debate in the literature as to how to treat them. CASE REPORT: A patient, 67-year old, was admitted to the Clinic due to a constipation over the last several months, increasing abdominal pain mainly localized in the left lower quadrant accompanied by nausea, vomiting and abdominal distension. Physical examination was unremarkable and the results of the detailed laboratory tests and carcinoembryonic antigen remained within normal limits. Colonoscopy revealed a large 10 cm long, and 4 to 5 cm in diameter, mobile lesion in his sigmoid colon. Conventional endoscopic ultrasound revealed 5 cm hyperechoic lesion of the colonic wall. Twenty MHz mini-probe examination showed that lesion was limited to the submucosa. Since polyp appeared too large for a single transaction, it was removed piecemeal. Once the largest portion of the polyp has been resected, it was relatively easy to place the opened snare loop around portions of the residual polyp. Endoscopic resection was carried out safely without complications. Histological examination revealed the common typical histological features of lipoma elsewhere. The patient remained stable and eventually discharged home. Four weeks later he suffered no recurrent symptoms. CONCLUSION: Colonic lipomas can be endoscopically removed safely eliminating unnecessary surgery.     

Clinical failure after uterine artery embolization: evaluation of patient and MR imaging characteristics

PURPOSE: To investigate the patient and magnetic resonance (MR) imaging characteristics associated with clinical failure after uterine artery embolization (UAE). MATERIALS AND METHODS: Seventy-eight consecutive patients who underwent UAE were examined. Contrast-enhanced MR imaging was performed before and 4 months after the procedure, and clinical follow-up was performed at 15 months. Patients were divided into success and failure groups strictly on the basis of their clinical outcomes. Clinical follow-up included evaluation of fibroid symptoms and the need for further treatment after UAE. Findings at pre- and postprocedural MR imaging were compared, and data collected included changes in uterine and fibroid volumes, fibroid location, and fibroid perfusion. RESULTS: Fifty-eight patients were placed into the success group and 20 into the failure group. There were no differences between the baseline characteristics of the two groups. The reduction in uterine and dominant fibroid volumes was greater in the success group compared with the failure group; however, the difference was not statistically significant (success group: [295/845] 34.9% vs [80/282.5] 28.3%, respectively, P=.18; failure group: [317/733] 43.2% vs [114/337.6] 33.9%, P=.32). The reduction in total fibroid volume was greater in the success group than the failure group ([189.6/393.5] 48.2% vs [148.7/439.9] 33.8%, respectively; P=.02) despite the fact that the percentage of fibroids completely infarcted was similar between the two groups ([136/172] 79% vs [41/50] 82%, P=.77). Pedunculated subserosal fibroids were more common in the failure group than in the success group (P<.03) and did not reduce in volume as significantly (53.8% vs 14.7%, respectively; P=.02). CONCLUSIONS: In general, the reduction in total fibroid volume after embolization is smaller in patients with poor clinical improvement. In addition, these patients have a higher number of pedunculated subserosal fibroids, and these fibroids tend to reduce in volume to a lesser extent.