子宫肌瘤超声消融剂量-效应关系研究

目的 采用能效因子（energy-efficiency factor,EEF）量化研究子宫肌瘤超声消融（ultrasound ablation,UA）的剂量-效应的规律性.方法 67例（81个肌瘤）子宫肌瘤患者接受超声引导下超声消融治疗,治疗后核磁共振成像评价超声消融的结果,计算EEF,并随访患者的满意度和临床不良反应.结果 所有的患者均未出现重要并发症,患者满意度100%.无灌注体积达70%以上的肌瘤有63例（77.78%）,EEF为（15.95±1.53）J/mm3;而消融不足70%的肌瘤18个（22.22%）,EEF为（34.50±5.65）J/mm3;不同消融率之间比较EEF值差异有统计学意义（P=0.000）;达到满意体积消融率（70%）所需的能量低于部分消融的肌瘤.结论 超声消融治疗子宫肌瘤是可行的、安全的,EEF可作为超声消融子宫肌瘤的剂量评价指标,用于剂量学研究.影响能效因子的因素需进一步研究.

Study of ultrasound dosimetry for ablating uterine fibroids

Objective Energy efficiency factor（EEF） was used to assess ultrasound dosimetry of ablation uterine fibroids. Methods A total of 67 patients with 81 uterine fibroids were enrolled and treated. Ultrasound ablation （UA） was performed un- der conscious sedation by using fentanyl and benzodiazepines, integrated with ultrasound imaging for real-time guidance. Con- trast-enhanced MR imaging was performed to evaluate the efficacy of thermal ablation whthin 7 days after ablation procedures; EEF were calculate to assess ultrasound dosimetry. Adverse events were recorded. Results All of the patients tolerated the procedure well and had excellent satisfactory. No serious adverse event was observed in any subject. The non-perfused volume was more than 70% in 63 fibroids （77. 78% ）. EEF measured （ 15.95 ＋ 1.53）J/ram3 ; Compared with group with non-perfused volume less than 70%, there was significant difference （P = 0. 000） ;Energy was lower in the complete ablation group than that in the part ablation group. Conclusion Focused ultrasound for ablating uterine fibroids is reliable and feasible. EEF could assess ultrasound dose of ablation uterine fibroids with an excellent correspondence. Advanced study is needed to be explored the influence factor on EEF.