高强度聚焦超声在治疗子宫肌瘤中的应用及疗效观察

目的:探讨高强度聚焦超声(HIFU)治疗子宫肌瘤的疗效及脉冲辐射力成像技术(ARFI)、超声造影在治疗前后的应用.方法:应用HIFU对515例子宫肌瘤患者进行治疗,观察治疗前后声像图的变化,比较治疗后病灶大小、回声、内部血流、临床症状等不同的改变,对其中42例治疗前、后分别行ARFI及超声造影检查对比.结果:185例治疗后肌瘤内部回声明显增强,周围及内部血流信号消失,瘤体缩小程度大于30％,临床症状完全改善,227例治疗后肌瘤内部回声部分增强,周围及内部血流信号减弱,瘤体缩小程度小于30％,临床症状有改善,103例治疗后肌瘤内部回声无增强,周围及内部血流信号无减少,瘤体增大,临床症状无明显改善;术后1月超声造影即发现造影剂充盈缺损,术后6月ARFI发现肌瘤横向剪切波速度值(Vs)有明显变化.结论:HIFU治疗子宫肌瘤疗效明确、安全可靠,是一种安全、有效、无创的临床治疗方法,超声造影可早期评价疗效并干预治疗,ARFI可评价后期疗效.

Application of High-Intensity Focused Ultrasound in the Treatment Uterine Fibroids

Objective: To study the outcomes of high-intensity focused ultrasound(HIFU) in the treatment of uterine fibroids,and to investigate the value of contrast-enhanced ultrasound(CUES) and acoustic radiation force-impulse(ARFI) technique in evaluating the effect of treatment.Methods: A total of 515 patients with uterine fibroids were treated by HIFU.Ultrasonographic changes were observed before and after treatment,and the size,intensity,internal blood flow signals,clinical symptoms changes of lesions were compared.Of the all the patients,42 were examined by CEUS and ARFI before and after treatment.Results: In 185 cases,the internal echoes were obviously enhanced,blood flow in or around the lesions disappeared,the size of lesion decreased by >30%,and clinical symptoms were relieved fully after treatment.In 227 cases,the internal echoes were partly enhanced,blood flow in or around the lesions reduced,the size of lesion decreased by <30%,and clinical symptoms were improved after treatment.While in the other 103 cases,the above indices had no improvement after treatment.After one month,CUES showed filling defects.After six months,ARFI results showed that the wave velocity of fibroids transverse shear changed obviously.Conclusion: HIFI treatment of uterine fibroids is effective,safe,reliable,and non-invasive.CEUS can be used to evaluate the outcomes early for interventional treatment,while ARFI can be used to evaluate the longer outcomes.