缩宫素辅助超声消融治疗子宫肌瘤的临床应用研究

发布时间：2018-03-17 02:25

  本文选题：子宫肌瘤　切入点：缩宫素　出处：《中国人民解放军医学院》2014年硕士论文　论文类型：学位论文

【摘要】：研究背景： 子宫肌瘤是育龄期妇女最常见的良性肿瘤，常因引起月经异常、盆腔压迫等症状或对患者生育造成不良影响而需要临床干预。随着社会的发展和医学的不断进步，更多的肌瘤患者希望在治疗肌瘤的同时能够保留子宫甚至生育能力。超声消融治疗子宫肌瘤安全、有效，且具有非侵入性、术后恢复快、可门诊治疗等优点，为有保留子宫意愿的肌瘤患者提供了一种新的治疗选择。缩宫素是有效的子宫收缩剂，已有研究证实缩宫素能使肌瘤内部及周边滋养血管血流频谱发生变化并明显降低超声消融子宫肌瘤辐照单点温度升高所需的能量和时间，预示缩宫素可能通过对肌瘤血流灌注产生影响进而提高超声消融子宫肌瘤的效率。 目的： 1.比较子宫肌瘤患者使用缩宫素前后肌瘤血流灌注的变化。 2.探讨缩宫素辅助超声消融子宫肌瘤的作用。 资料和方法： 1.缩宫素对子宫肌瘤血流灌注的影响（自身前后对照研究）：分别于使用缩宫素前后对肌瘤进行超声造影检查，动态观察子宫肌瘤的血流灌注变化，对肉眼未观察到显著变化的患者增加剂量再次观察。使用软件对造影图像进行脱机分析，绘制时间-强度曲线，得出反映肌瘤灌注的各项定量参数。 2.缩宫素辅助超声消融子宫肌瘤的作用（随机对照研究）：将符合入组条件的子宫肌瘤患者按就诊顺序随机分为2组，实验组治疗中使用微量泵静脉持续泵入缩宫素，对照组泵入生理盐水，治疗后通过增强核磁或超声造影检查比较两组患者消融疗效的差异。 结果： 1.缩宫素对子宫肌瘤血流灌注的影响：共52例患者54枚肌瘤纳入研究，，其中48例患者50(92.6%)枚肌瘤静脉给予低剂量(0.1U/min)缩宫素15分钟后肌瘤血流灌注参数变化显著，用药前肌瘤达峰时间(TTP)、峰值强度(Imax(%))、平均渡越时间(MTT)分别为(15.8±4.9)s、(108.8±69.8)%、(73.4±34.4)s，使用缩宫素后分别为(31.4±19.7)s、(17.1±20.4)%、(130.1±121.6)s，肌瘤TTP和MTT显著延长，Imax(%)显著降低，差异具有统计学意义(P0.05)。4例患者低剂量缩宫素肌瘤血流灌注肉眼未观察到显著变化，增加剂量至0.4U/min(高剂量)后再次观察，用药前、低剂量和高剂量缩宫素后肌瘤平均Imax(%)分别为(125.0±18.2)%、(103.9±37.5)%、(86.4±11.4)%。 2.缩宫素辅助超声消融子宫肌瘤的作用：共17例患者17枚核磁T2低信号肌瘤纳入研究，缩宫素组10例，对照组7例。 (1.)两组患者平均年龄分别为(36.3±5.6)岁和(39.7±2.9)岁,(P=0.196)；肌瘤均径分别为(64.2±8.9)cm和(61.3±8.7)cm,(P=0.525)；腹壁厚度分别为(23.0±4.3)mm和(27.8±5.1)mm,(P0.05)；腹壁皮肤距肌瘤最深面距离分别为(92.3±12.6)mm和(94.1±14.0)mm,(P=0.896)，以上指标均无统计学差异。 (2.)缩宫素组和对照组消融单位体积肌瘤所需能量分别为(4.8±1.6)J/mm3和(7.5±1.9)J/mm3，(P=0.007)；肌瘤平均消融率分别为(88.5±11.8)%和(69.2±15.9)%，(P=0.01)；单位体积肌瘤辐照时间分别为(9.2±3.3)s/cm3和(12.6±4.6)s/cm3,(P=0.09)。缩宫素组消融单位体积肌瘤所需能量显著低于对照组而肌瘤消融率显著高于对照组，差异具有统计学意义，单位体积肌瘤辐照时间无统计学差异。 结论： 子宫肌瘤患者持续静滴0.1U/min剂量的缩宫素可显著减少大部分肌瘤(50/54)的血流灌注，在超声消融子宫肌瘤时使用可以显著降低消融所需能量，提高消融率。
[Abstract]:Research background:
Uterine leiomyoma is the most common benign tumor in women of childbearing age, often caused by abnormal menstruation, pelvic compression and other symptoms or adverse effects on the fertility of patients and the need for clinical intervention. With the development of society and medicine, more hope to be able to retain the uterus myoma and fertility while treating myoma. Ultrasound ablation treatment uterine fibroids safe, effective, and non intrusive, fast postoperative recovery, but outpatient treatment etc., and provides a new treatment option for patients with myoma of uterus retaining intention. Oxytocin is effective uterine contraction agent, studies have confirmed that oxytocin can nourish blood vessels within and around the myoma the spectrum changes and a significant decrease of ultrasound ablation for uterine fibroids by single point temperature increased energy and time required, indicate that oxytocin may produce effects on fibroids perfusion The efficiency of ultrasonic ablation of myoma of uterus was further improved.
Objective:
1. compare the changes of blood perfusion of myoma in the patients with uterine myoma before and after the use of oxytocin.
2. to investigate the role of oxytocin assisted ultrasound ablation of uterine myoma.
Information and methods:
1. effect of oxytocin on uterine fibroids perfusion (self control study): respectively using oxytocin before and after the myoma were examined by CEUS, dynamic perfusion changes of uterine fibroids, to the naked eye is not observed significant changes with increasing dose again observation. Use the software for offline analysis contrast image. The rendering time intensity curve, can reflect the quantitative parameters of fibroids perfusion.
2. oxytocin assisted ultrasound ablation for uterine leiomyoma (randomized controlled trials): eligible patients of uterine fibroids were randomly divided into 2 groups, the use of micro pump intravenous infusion of oxytocin treatment in experimental group, the control group is pumped into the saline, difference after treatment by enhanced magnetic resonance or contrast-enhanced ultrasound ablation were compared between the two groups.
Result锛

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