子宫肌瘤射频消融术后短期疗效评估的超声影响因素分析

目的分析子宫肌瘤射频消融（RFA）术后超声指标和特征，探讨影响RFA术后短期疗效评估结果的超声相关因素。 方法选取2015年6月至2018年3月于哈尔滨医科大学附属第四临床医学院接受子宫肌瘤RFA治疗的患者71例，依据术后3个月的临床症状、瘤体直径减小率及超声造影结果将患者分为疗效优组46例，疗效良组25例。所有患者均于RFA前行常规二维超声、彩色多普勒血流成像（CDFI）、超声弹性成像及超声造影检查。对肌瘤位置、数目、大小、边界、内部回声、CDFI血流、造影模式及造影剂分布特征等相关因素进行统计，分析影响子宫肌瘤RFA短期疗效评估结果的术前超声特征。 结果疗效优组与疗效良组比较，肌瘤回声强度、有无粗大供养血管、肌瘤CDFI血流分级、病灶弹性指数（E1）与周围肌层弹性指数（E2）比值（E1/E2）、超声造影增强模式、造影剂分布特征6项因素差异具有统计学意义（χ²=10.87、4.70、12.81、8.23、10.99、3.92，P均<0.05）。Logistic多因素回归分析显示高回声肌瘤（OR=8.93，95%CI：1.79~58.89，P=0.012）、CDFI血流分级Ⅱ~Ⅲ级（OR=9.89，95%CI：2.39~53.39，P=0.003）、E1/E2>1（OR=11.66，95%CI：2.73~70.50，P=0.002）、超声造影剂分布不均匀（OR=5.84，95%CI：1.45~30.29，P=0.020）是预测子宫肌瘤RFA术后疗效良的独立危险因素。 结论术前超声检查可为子宫肌瘤RFA术前评估疗效及判断预后提供参考依据，对于存在术后疗效预测结果为良的危险因素的子宫肌瘤患者应合理优化RFA术前及术中治疗方案，以达到预期的治疗效果。

Ultrasound related risk factors for assessing short-term efficacy of radio frequency ablation for uterine fibroids

ObjectiveTo investigate the ultrasound characteristics of uterine fibroids after radio frequency ablation (RFA) and explore the application of ultrasound in assessing the short-term efficacy of RFA for uterine fibroids. MethodsFrom June 2015 to March 2018, 71 patients who received radiofrequency ablation for uterine fibroids at the Fourth Affiliated Hospital of Harbin Medical University were included. According to the clinical symptoms, reduction rate of tumor diameter, and contrast-enhanced ultrasound results at 3 months after RFA, the patients were divided into an excellent efficacy group and a good efficacy group, which included 46 cases and 25 cases, respectively. A retrospective analysis of data regarding conventional 2D ultrasound, color Doppler flow imaging (CDFI), ultrasonic elastography, and contrast-enhanced ultrasonography among 71 patients who met the inclusion criteria was performed to identify the preoperative ultrasound characteristics associated with the assessment of short-term efficacy of RFA for uterine fibroids. ResultsUnivariate analysis showed that hyperechoic fibroids, extensive vascular supply, grade Ⅱ-Ⅲ CDFI blood flow classification, ratio of myoma (E1) to normal muscle layer elasticity (E2) >1, high enhancement on ultrasonography, and uneven distribution of ultrasound contrast agents differed significantly between the two groups (χ²=10.87, 4.70, 12.81, 8.23, 10.99, and 3.92, respectively, P<0.05). Logistic multivariate analysis revealed that hyperechoic fibroids (OR=8.93, 95%CI: 1.79~58.89, P=0.012), CDFI blood flow grade Ⅱ-Ⅲ (OR=9.89, 95%CI: 2.39~53.39, P=0.003), E1/E2>1 (OR=11.66, 95%CI: 2.73~70.50, P=0.002), and uneven distribution of ultrasound contrast agents (OR=5.84, 95%CI: 1.45~30.29, P=0.020) were independent risk factors to predict the efficacy of RFA for uterine fibroids. ConclusionPreoperative ultrasound may be used to predict the short-term curative effect of RFA for uterine fibroids, helping optimize the radiofrequency ablation treatment plan and select reasonable treatment for patients with risk factors that can predict the efficacy of RFA for uterine fibroids.