HIFU治疗肌壁间子宫肌瘤与浆膜下子宫肌瘤的对比研究

发布时间：2018-04-14 06:14

本文选题：高强度聚焦超声 + 肌壁间子宫肌瘤　；参考：《重庆医科大学》2014年硕士论文

【摘要】：目的：探讨HIFU治疗肌壁间子宫肌瘤与浆膜下子宫肌瘤的临床疗效及安全性有无差异。方法：对符合入选条件的158例肌壁间子宫肌瘤和103例浆膜下子宫肌瘤两组患者进行对比研究，比较两类肌瘤患者临床症状、HIFU剂量学参数（平均声强、总能量等）、治疗中及治疗后3天内副反应，以及HIFU后的疗效，如体积消融率、治疗后3月、6月、12月彩色多普勒超声随访肌瘤体积缩小情况。采用症状严重程度亚量表（UFS-8）评价治疗后12月子宫肌瘤随访症状缓解情况，并对两组患者的变化进行比较。观察两组患者的不良反应，，评价HIFU治疗两组患者的安全性。结果： 1.两组患者HIFU前的年龄及临床症状（月经量增多、痛经、尿频、便秘及贫血）无明显差异（P＞0.05）。治疗后12月采用症状评分评价两组患者的症状改善情况，并对两组患者症状改善情况进行比较，结果显示两组患者症状评分降低值的差异无统计学意义（P＞0.05），提示HIFU均能有效改善两组患者症状，且改善效果无统计学差异。 2.所有患者均顺利完成治疗。肌壁间子宫肌瘤与浆膜下子宫肌瘤的平均体积、平均声强、体积消融率对比无差异（P＞0.05），但辐照时间、总能量对比存在明显差异（P＜0.01）。 3.所有患者HIFU治疗中及治疗后3天内副反应均无严重副反应发生。HIFU治疗中，两组患者间骶尾部痛、治疗区域痛的发生率具有统计学意义（P＜0.05），而放射痛、皮肤烫、腹股沟痛、臀部皱褶处疼痛及其他副反应发生率无统计学意义（P＞0.05）；此外，观察到肌壁间子宫肌瘤组患者耻骨联合疼痛1例、肛门坠胀1例、心率和血压降低1例，浆膜下子宫肌瘤组患者耻骨联合上方刺痛1例。HIFU治疗后3天，两组患者间发热、下腹部痛、骶尾部痛、下肢感觉运动功能异常、阴道排液、皮肤损伤等副反应发生率无统计学意义（P＞0.05）；此外，观察到肌壁间子宫肌瘤组患者血尿1例、两侧腹股沟区疼痛1例，浆膜下子宫肌瘤组小便刺痛1例。 4.评价HIFU治疗后两组患者的疗效，除肌壁间子宫肌瘤组有3例临床治疗无效外，余肌瘤HIFU治疗均有效。治疗后3月、6月、12月随访两组肌瘤体积均逐渐缩小，且比较两组肌瘤体积缩小率，其差异无统计学意义（P＞0.05）。结论： 1. HIFU能安全有效治疗肌壁间子宫肌瘤及浆膜下子宫肌瘤，表明HIFU是肌壁间、浆膜下子宫肌瘤患者的一种可选择的安全有效的治疗方法。 2.尽管HIFU治疗肌壁间子宫肌瘤较浆膜下子宫肌瘤所需辐照时间更长、总能量更高，但HIFU均能有效治疗两类肌瘤。
[Abstract]:Objective:To explore the clinical efficacy and safety of HIFU in the treatment of intramural uterine myoma and subserous uterine myoma.Methods:A comparative study was conducted between 158 patients with intramural hysteromyoma and 103 patients with subserous uterine myoma. The clinical symptoms of the two types of leiomyomas were compared with those of HIFU dosimetry parameters (mean sound intensity).Total energy isobaric, side effects during treatment and 3 days after treatment, and curative effect after HIFU, such as ablation rate of volume, 3 months, 6 months and 12 months after treatment, were followed up by color Doppler ultrasound.Symptom severity subscale (UFS-8) was used to evaluate the symptom relief of uterine leiomyoma 12 months after treatment and to compare the changes between the two groups.To observe the adverse reactions of the two groups and to evaluate the safety of HIFU in the treatment of the two groups.Results:1.There was no significant difference in age and clinical symptoms (increased menstrual volume, dysmenorrhea, frequent urination, constipation and anemia) between the two groups before HIFU (P > 0.05).Symptom scores were used to evaluate the improvement of symptoms in the two groups 12 months after treatment, and the improvement of symptoms was compared between the two groups.The results showed that there was no significant difference in symptom score between the two groups (P > 0.05). The results indicated that HIFU could effectively improve the symptoms of the two groups, and there was no significant difference in the improvement effect between the two groups.2.All patients were successfully treated.There was no significant difference in the mean volume, average sound intensity and volume ablation rate between myoma and subserous uterine myoma (P > 0.05), but there was significant difference in irradiation time and total energy (P < 0.01).3.There were no severe side effects in all patients treated with HIFU and within 3 days after treatment. The incidence of sacrococcygeal pain between the two groups was statistically significant (P < 0.05), while radiation pain, scalding skin and groin pain were found in all patients.There was no significant difference in the incidence of pain and other side effects in the rump folds (P > 0.05). In addition, one case of symphysis pubis pain, one case of anal distension, and one case of heart rate and blood pressure decrease were observed in the myoma group.One case of suprapubic prickly pain in subserous uterine leiomyoma group. 3 days after HIFU treatment, there were fever, lower abdomen pain, sacrococcygeal pain, lower extremity sensorimotor dysfunction, vaginal effusion between the two groups.There was no significant difference in the incidence of side effects such as skin injury (P > 0.05). In addition, 1 case of hematuria, 1 case of bilateral inguinal area pain and 1 case of urinal stinging pain in subserous uterine myoma group were observed in the myoma group.4.To evaluate the efficacy of HIFU in the treatment of intramural uterine leiomyoma, except for 3 cases of myoma of the muscle wall, HIFU was effective in the treatment of residual myoma.Three months, six months and twelve months after treatment, the volume of myoma in the two groups was gradually reduced, and there was no significant difference between the two groups in the reduction rate of myoma volume (P > 0.05).Conclusion:1.HIFU is a safe and effective method for the treatment of intramural myoma and subserous uterine myoma, indicating that HIFU is a safe and effective method for the treatment of myomembranous and subserous uterine leiomyoma.2.Although HIFU takes longer irradiation time and higher total energy than subserous hysteromyoma, HIFU can effectively treat both types of myoma.
【学位授予单位】：重庆医科大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R737.33

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