射频消融术靶位治疗子宫肌瘤临床疗效研究

目的 探讨射频消融术靶位治疗子宫肌瘤的临床疗效.方法 选择暨南大学附属第一医院、武汉大学人民医院和陨阳医学院十堰市太和医院妇产科2001年8月至2006年12月经临床和超声检查确诊为子宫肌瘤的260例患者,在超声监视和引导下经阴道进行射频消融治疗,于术后第1、3、6和12个月随访.其中56例于治疗前和治疗后6个月同时行盆腔彩超检查子宫和卵巢血流的改变,放射免疫法检测卵巢和垂体激素水平变化.结果 治疗后6个月72.67%月经恢复正常,64.71%痛经消失,64.81%下腹不适和膀胱、直肠压迫症状均消失.治疗后12个月82.56%患者月经恢复正常,74.51%痛经消失,72.22%下腹不适和膀胱、直肠压迫症状均消失.射频消融治疗术后子宫及其肌瘤体积呈进行性缩小,治疗术后6个月和12个月肌瘤体积缩小率为69.56%和76.38%,子宫体积缩小率为42.29%和46.27%.术后6个月和12个月总有效率分别为95.38%和97.69%.子宫肌瘤患者子宫动脉血液供应比健康妇女丰富（P＜0.05）,治疗后明显降低,与健康妇女无明显差别.卵巢动脉血液供应、卵巢性激素、垂体促性腺激素水平治疗后与治疗前无明显变化,与健康妇女比较差异无显著性意义（P＞0.05）.全部治疗病例无严重并发症.结论 射频消融术靶位治疗子宫肌瘤临床疗效好,创伤小,安全性高.

Clinical effects of radiofrequency ablation on uterine myomas

Objective To assess the clinical effects of radiofrequency ablation(RFA) on uterine leiomyomas.Methods A total of 260 patients with uterine leiomyoma treated by RFA were followed up for 12 months.Ultrasonic imaging and clinical evaluation were obtained preoperatively and after 6 and 12 months.Before and after six months of treatment,56 patients were given observation with the blood perfusion of uterus and ovary being examined by pelvic color doppler ultrasonogrphy,and the hormone of ovary and pituitary were measured by radioimmunoassay.Results Menstruation restored to normal in 72.67% of the patients;dysmenorrhea and pelvic pressure disappeared in 64.70% and 64.81% after six months of treatment,with an overall effective rate of 95.38%.Menstruation restored to normal in 82.56% of the patients;dysmenorrhea and pelvic pressure disappeared in 74.50% and 72.22% after twelve months of treatment,with an overall effective rate of 97.69%.The size of leiomyoma and that of the uterus decreased by 69.56%,76.38%,and 42.29%,46.27% at 6 and 12 months after radiofrequency ablation respectively.The blood perfusion of ovarian artery,ovarian hormone,pituitary gonadotropin had no obvious change before and after treament,and they have no obvious difference from normal patients(P>0.05).After radiofrequency ablation,patients had no serious complication.Conclusion RFA is an effective and satisfactory method for the treatment of uterine leiomyoma with little trauma and high safty.