超声引导高强度聚焦超声治疗肌壁间子宫肌瘤的效果

目的探讨超声引导高强度聚焦超声(HIFU)治疗肌壁间子宫肌瘤的效果及其对前、后壁子宫肌瘤疗效的差异。方法对54例症状性肌壁间子宫肌瘤患者行超声引导下HIFU治疗;消融后当日或次日及术后3个月时行增强MR检查,评估肌瘤消融范围并计算消融率:消融率≥50%为显效,0<消融率<50%为有效,增强信号无减低为消融无效。结果共消融治疗肌壁间子宫肌瘤57个,其中前壁肌瘤32个,后壁肌瘤25个;消融前肌瘤体积为16.27～502.12cm3,消融后增强MRI显示无灌注区域体积为5.75～292.42cm3,平均消融率为(68.14±16.19)%,显效率为89.47%(51/57),有效率为100%(57/57)。3个月后消融肌瘤无灌注区域体积较术后1天或次日进一步缩小(t=6.365,P<0.05)。前壁肌瘤平均消融率为(74.35±12.24)%,后壁肌瘤平均消融率为(60.93±17.62)%,差异有统计学意义(t=2.366,P<0.05)。结论超声引导HIFU治疗肌壁间子宫肌瘤安全、有效,对前壁肌瘤的消融率高于后壁肌瘤。

Efficacy of US-guided high-intensity focused ultrasound ablation for the treatment of intramural leiomyoma

Objective To explore the efficacy of US-guided high-intensity focused ultrasound （HIFU） ablation for the treatment of intramural leiomyoma, and to observe the difference of ablation rate between anterior and posterior intramural leiomyoma. Methods Fifty-four patients with intramural leiomyoma diagnosed by MRI were enrolled, who underwent US- guided HIFU ablation. The day or the next day and 3 months after ablation, the volume of the nomperfused fibroids was observed on contrast-enhanced MRI to calculate the ablation rate. The treatment outcome was divided into three categories： Excellent （ablation rate≥50%）, effective （0〈ablation rate〈50%）, ineffectiveness （ablation rate=0）. Results Totally fifty-seven leiomyomas were treated, including 32 anterior and 25 posterior intramural leiomyomas. The volume of pretreat- ment leiomyomas were 16.27--502.12 cma , and the non-perfused region volume were 5.75-292.42 cm3 after treatment. The mean ablation ratio was （68. 14±16.19）%, and the excellent rate was 89.47% （51/57）, the effective rate was 100% （57/57）. Three months later, the volume of non-perfused region shrank rapidly than that of the first day or the next day after ablation （t = 6. 365, P〈0.05）. The mean ablation rate of anterior leiomyomas was （74.35 ± 12.24）%, of posterior leiomyomas was （60.93± 17.62）% （t= 2. 366, P〈0.05）. Conclusion US-guided HIFU ablation may be a safe and effective treatment for intramural leiomyoma. The therapeutic efficacy of HIFU for anterior leiomyomas is better than that of posterior ones.