超声造影剂在超声消融子宫肌瘤时的增效作用及安全性评价

发布时间：2018-01-15 06:23

  本文关键词：超声造影剂在超声消融子宫肌瘤时的增效作用及安全性评价　出处：《重庆医科大学》2014年硕士论文　论文类型：学位论文

  更多相关文章： 高强度聚焦超声 超声造影剂 子宫肌瘤

【摘要】：研究背景： 子宫肌瘤是育龄女性最常见的良性肿瘤，发病率为20-40%，其中50%的患者有临床症状而需要治疗，高强度聚焦超声（HIFU）能安全有效用于消融子宫肌瘤，并且作为一种非侵入治疗手段，得到了越来越多的认可。但如何进一步提高HIFU消融效果，缩短治疗时间，一直是临床研究的重点。超声造影剂（声诺维），主要成分为六氟化硫微泡，超声微泡可改变声环境。回顾性研究显示使用超声造影剂（声诺维）在超声消融治疗子宫肌瘤时可能起到增效作用，但目前尚未见超声造影剂（声诺维）提高HIFU消融子宫肌瘤效率的前瞻性研究的报道。 目的: 探讨超声造影剂（声诺维）在高强度聚焦超声消融治子宫瘤时的增效作用及安全性评价。 资料和方法: 使用由重庆海扶技术有限公司研制的高强度聚焦超声肿瘤治疗系统（JC200），在遂宁市中心医院选择确诊的80例单发子宫肌瘤患者,随机分为造影剂组（40例）和非造影剂组（40例）。造影剂组在HIFU手术前后均静脉推注1.5ml超声造影剂（声诺维），非造影剂组仅在HIFU术后静脉推注1.5ml超声造影剂（声诺维），比较造影剂组和非造影剂组的团块状灰度变化出现率、EEF、消融率以及HIFU术中、HIFU术后即刻不良反应发生率等。 结果： （1）造影剂的40例患者中有33个(82.5%)肌瘤治疗时出现团块状灰度变化， EEF（消融单位体积病灶组织所需的超声能量）为9.1±9.9(范围:0.4-56.8)J/mm3,消融率为90.4±8.3(范围:66.4-100)%；在未使用造影剂的40例患者中，有20个(50.0%)肌瘤治疗时出现团块状灰度变化，EEF为12.9±15.7(范围:1.5-71.1)J/mm3，消融率为82.8±13.3(范围:53.4-100)%，其P值分别为0.002、0.029、0.006，均0.05，有统计学差异。 （2）HIFU术中造影剂组：放射痛12.5%、骶尾部痛60%、皮肤烫57.5%、治疗区痛57.5%、腹股沟痛5.0%、无臀部皱褶痛、肛门坠胀2.5%、耻骨联合痛2.5%、臀部痛2.5%，非造影剂组：放射痛87.5%、骶尾部痛72.5%、皮肤烫77.5%、治疗区痛67.5%、腹股沟痛17.5%、臀部皱褶痛10%、肛门坠胀2.5%、无耻骨联合痛、无臀部痛，其P值分别为：0、0.469、0.056、0.356、0.077、0.051、1、0.314、0.314，均0.05，无明显差异。 （3）HIFU术后即刻造影剂组：无发热、下腹痛47.5%、骶尾部痛。25.0%、无下肢感觉异常、阴道排液5.0%、皮肤损伤2.5%、无肛门坠胀，非造影剂组：无发热、下腹痛42.5%、骶尾部痛30.0%、无下肢感觉异常、阴道排液7.5%、无皮肤损伤、肛门坠胀2.5%，其P值分别为：1、0.653、0.617、1、0.644、0.314、0.314，均0.05，，无明显差异。 结论： 超声造影剂（声诺维）能提高HIFU消融子宫肌瘤的作用，减少HIFU治疗的能量，无明显不良反应，具有很好的临床应用价值，值得进一步推广研究。
[Abstract]:Research background:
Uterine leiomyoma is the most common benign tumor of women of childbearing age, the incidence rate was 20-40%, of which 50% of the patients had clinical symptoms and the need for treatment of high intensity focused ultrasound (HIFU) is safe and effective for ablation of uterine fibroids, and as a non-invasive treatment, has been more and more recognized. But how to further improve the HIFU the ablation effect, shorten treatment time, has been the focus of clinical research. Ultrasound contrast agent (SonoVue), is mainly composed of six sulfur hexafluoride microbubbles, ultrasound microbubbles can change the acoustic environment. A retrospective study showed that the use of ultrasound contrast agent (SonoVue) in ultrasound ablation in treatment of uterine fibroids may play a synergistic effect. But there is no ultrasound contrast agent (SonoVue) to improve the prospective study of HIFU ablation for uterine fibroids efficiency reports.
Objective:
Study of ultrasound contrast agent (SonoVue) ablation synergistic effect and safety evaluation of the treatment of uterine tumor with high intensity focused ultrasound.
Information and methods:
The use of high intensity focused ultrasound tumor therapy system developed by Chongqing Haifu Technology Co. Ltd. (JC200), were chosen in Suining Central Hospital 80 cases of patients with single uterine fibroids were randomly divided into the contrast group (40 cases) and contrast group (40 cases). Contrast group in the HIFU vein before and after operation infusion of 1.5ml ultrasound contrast agent (SonoVue), non contrast group only at HIFU after intravenous injection of 1.5ml ultrasound contrast agent (SonoVue), contrast agent group and the mass of gray change non contrast agent group occurrence rate, EEF, HIFU and ablation rate during operation, postoperative adverse reactions immediately HIFU occurrence rate.
Result锛

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