子宫肌瘤的超声造影灌注特性与超声消融效率的相关性研究

发布时间：2018-04-27 09:33

本文选题：子宫肌瘤 + 高强度聚焦超声　；参考：《重庆医科大学》2016年硕士论文

【摘要】：目的:子宫肌瘤的超声造影(Contrast-enhanced ultrasound,CEUS)灌注特性与肌瘤血供相关,本研究根据子宫肌瘤超声造影达峰值时的灌注特性的不同进行分组,通过比较其行高强度聚焦超声(High intensity focused ultrasound,HIFU)消融治疗后消融率、能效因子(Energy efficiency factor,EEF)、消融效率、治疗时疼痛发生率及疼痛评分的差异,探讨导致消融疗效、能效因子、消融效率、治疗时疼痛发生率及疼痛评分存在差异的可能性因素,为HIFU消融治疗子宫肌瘤的疗效进行预判,为指导临床适应症优化提供依据。方法:根据接受HIFU治疗的62例子宫肌瘤患者行超声造影检查灌注达峰值时的图像特征的类型分为两组:均匀高增强组和非均匀高增强组。比较两组的平均功率、治疗时间、辐照时间、治疗强度、能效因子、消融率、消融效率、治疗时疼痛发生率及疼痛评分。结果:62例子宫肌瘤患者在超声造影过程中显影达到峰值时,其中30例表现为整个病灶呈均匀高增强,接近子宫正常肌层的增强时间和水平,为均匀高增强组;另32例中部分表现为不均匀增强,其余部分患者表现为均匀增强但增强强度明显弱于正常子宫肌层,为非均匀高增强组。hifu消融治疗后均匀高增强组和非均匀高增强组的平均消融率分别为68(范围:13-98)%和77.6(范围:57-99)%,非均匀高增强组明显高于均匀高增强组(p0.05)。均匀高增强组和非均匀高增强组的能效因子分别为10(范围:2.3-90.1)j/mm3和2.9(范围:0.4-8.7)j/mm3,非均匀高增强组明显低于均匀高增强组(p0.05)。均匀高增强组和非均匀高增强组的平均消融效率分别为50.7(范围:2.6-121.9)mm3/s和150.7(范围:32.2-635.9)mm3/s,两者之间有显著差异(p0.05)。均匀高增强组子宫肌瘤患者疼痛评分为3.7±0.7分(范围:3-6分),而非均匀高增强组子宫肌瘤患者疼痛评分为2.6±0.7分(范围:2-4分),两组之间存在显著差异(p0.05)。均匀高增强组子宫肌瘤患者治疗区疼痛、皮肤烫、骶尾部疼痛及下肢放射痛的发生率均高于非均匀高增强组子宫肌瘤患者(p0.05)。而两组患者的腹股沟疼痛和臀部褶皱区疼痛无显著差异(p0.05)。结论:本研究中,超声造影灌注达峰值时呈均匀高增强类型的子宫肌瘤患者和呈非均匀高增强类型的子宫肌瘤患者接受hifu消融治疗均安全有效,而均匀高增强组比非均高增强组子宫肌瘤hifu消融困难,hifu消融治疗后消融率较低,hifu消融治疗时患者疼痛发生率及疼痛评分较高。子宫肌瘤超声造影灌注特性可用于预测hifu消融治疗子宫肌瘤的消融疗效,值得更深入的研究。
[Abstract]:Objective: the perfusion characteristics of hysteromyoma with Contrast-enhanced ultrasound usus were correlated with the blood supply of hysteromyoma. By comparing the ablation rate, energy efficiency factor, ablation efficiency, pain incidence and pain score after high intensity focused ultrasound (HIFU) ablation, the effects of ablation, energy efficiency factors and ablation efficiency were discussed. The possible factors of the difference in pain incidence and pain score during the treatment provided a basis for guiding the optimization of clinical indications for the treatment of uterine leiomyoma by HIFU ablation. Methods: 62 patients with uterine leiomyoma treated with HIFU were divided into two groups: homogeneous high enhancement group and non uniform high contrast enhancement group. The mean power, treatment time, irradiation time, therapeutic intensity, energy efficiency factor, ablation rate, ablation efficiency, pain incidence and pain score were compared between the two groups. Results in 62 cases of uterine leiomyoma, the enhancement time and level of the normal myometrium were similar to that of the normal myometrium in 30 of the 62 cases with hysteromyoma. In the other 32 cases, some of them showed uneven enhancement, others showed homogeneous enhancement, but the intensity of enhancement was significantly weaker than that of normal uterine myometrium. The average ablation rate was 68% (range: 13-98%) and 77.6% (range: 57-99%) in the homogeneous high enhancement group and non-uniform high enhancement group after ablation treatment. The average ablation rate of the non-uniform high enhancement group was significantly higher than that of the homogeneous high enhancement group (P 0.05), and that of the non-uniform high enhancement group was significantly higher than that of the homogeneous high enhancement group (P < 0.05). The energy efficiency factors of homogeneous high enhancement group and non uniform high enhancement group were 10 (range: 2.3-90.1 g / mm3 and 2.9) (range: 0.4-8.7 J / m ~ (3), respectively). The energy efficiency factor of non-uniform high enhancement group was significantly lower than that of homogeneous high enhancement group (P 0.05). The average ablation efficiency was 50.7 (range: 2.6-121.9 mm 3 / s) and 150.7 (range: 32.2-635.9 mm 3 / s, respectively) in homogeneous high enhancement group and non-uniform high enhancement group. There was significant difference between the two groups (p 0.05). The pain score of hysteromyoma patients in homogeneous high enhancement group was 3.7 卤0.7 (range: 3-6), while that in non-homogeneous high enhancement group was 2.6 卤0.7 (range 2-4). There was a significant difference between the two groups (p 0.05). The incidence of pain, skin ironing, sacrococcygeal pain and lower extremity radiation pain in patients with uterine leiomyoma in homogeneous and high enhancement group was higher than that in patients with uterine leiomyoma in non-uniform high enhancement group (P 0.05). There was no significant difference in groin pain and hip fold pain between the two groups (p 0.05). Conclusion: in this study, hifu ablation is safe and effective in patients with hysteromyoma with homogeneous and high enhancement at peak perfusion. However, the ablation rate of hifu ablation difficulty in homogeneous high enhancement group was lower than that in non-uniform high enhancement group. The incidence of pain and pain score were higher in patients with homogeneous and high enhancement than those in non-uniform enhancement group. The characteristics of ultrasound perfusion in uterine leiomyoma can be used to predict the ablation effect of hifu ablation for uterine leiomyoma, which is worthy of further study.
【学位授予单位】：重庆医科大学
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R445.1;R737.33

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