HIFU治疗不同大小子宫肌瘤的对比研究

发布时间：2018-06-15 02:21

本文选题：高强度超声聚焦 + 子宫肌瘤　；参考：《福建中医药大学》2017年硕士论文

【摘要】：目的:子宫肌瘤是育龄期女性中的常见病、多发病,容易诊断,但需要个性化治疗。高强度聚焦超声(HIFU)技术为子宫肌瘤的治疗提供了一种新选择。随着HIFU治疗子宫肌瘤的发展,人们对HIFU的有效性及安全性进行深入研究,其中,子宫肌瘤大小对HIFU治疗子宫肌瘤的影响尚不明确,本文旨在研究HIFU治疗不同大小子宫肌瘤的疗效和安全性之间的差异,为HIFU治疗子宫肌瘤的筛选及预后判断提供理论基础。方法:本研究选择符合入选标准2016年2月到2016年12月于四川省遂宁中心医院行高强度超声聚焦治疗的单发子宫肌瘤患者共120例,按照肌瘤最大径d分为以下4组,分别为第一组(1cm≤d3cm)30例、第二组(3cm≤d5cm)30例、第三组(5cm≤d7cm)30例、第四组(d≥7cm)30例,通过对比HIFU治疗后的疗效,包括即刻体积消融率、治疗后1月、3月随访肌瘤缩小情况、采用子宫肌瘤症状严重程度亚量表(UFS)评价治疗后3月子宫肌瘤患者症状缓解情况,以及治疗中和治疗后不良反应及并发症,分析及评价HIFU治疗四组患者的临床疗效及安全性。为进一步指导临床实践,优化治疗方法,预测治疗疗效提供客观的理论依据。结果:1.四组患者一般临床资料,包括年龄、BMI、腹壁厚度、肌瘤深面距骶骨距离、MRIT2信号、肌瘤位置、类型无明显差异,具有可比性(P0.05)。2.HIFU治疗剂量学参数对比,四组间治疗功率无明显差异(P0.05),而辐照时间、治疗强度、总能量两两对比,各组之间存在差异(P0.05),随肌瘤直径的增大,辐照时间、治疗强度、总能量呈逐渐递增。3.所有患者均顺利完成HIFU治疗,各组获得的即刻体积消融率(%)分别为 86.00±12.50、87.91±7.92、86.52±10.06、87.79±10.12,对比无统计学意义(P0.05)。4.四组患者术后随访1月子宫肌瘤缩小率(%)分别为36.59±15.74、38.73±19.22、34.84±14.82、33.66±19.66,术后 3 月分别为 53.64±8.80、56.99±21.47、51.25± 17.61、54.06±22.18,组间对比均无明显差异(P0.05)。5.接受HIFU治疗的120例患者中有症状子宫肌瘤患者93例,术后3月随访结果共有90例患者症状评分较术前有不同程度的下降,术后评分明显低于术前评分(P0.01),对比四组患者的症状评分下降率无明显差异(P0.05)。6.术中患者报告的不良反应有骶尾部、腹部、腹股沟、臀部疼痛,放射痛、皮肤烫,比对术中不良反应发生率无明显差异(P0.05)。随访HIFU术后发生的不良反应,包括下腹部疼痛、发热、骶尾部痛、阴道排液、皮肤损伤,其中下腹痛疼痛的发生率最高,且第一、二、三组患者的发生率均低于第四组患者(P0.05),余不良反应发生率各组间对比无统计学意义。根据SIR分级,术后不良反应均属于SIRA-B级轻度不良反应,对比无显著性差异(P0.05)。结论:1.子宫肌瘤直径越大,高强度超声聚焦治疗子宫肌瘤的治疗强度、辐照时间、总能量越多,但肌瘤大小不影响HIFU治疗的近期疗效和安全性。2.HIFU均能安全有效治疗各种大小的子宫肌瘤,尤其对于肌瘤最大径7cm的子宫肌瘤患者可以做为一种安全有效的治疗方式。
[Abstract]:Objective: myoma of uterus is a common disease in women of childbearing age. It is frequently occurring and easy to diagnose, but it needs individualized treatment. High intensity focused ultrasound (HIFU) provides a new choice for the treatment of uterine leiomyoma. With the development of HIFU in the treatment of uterine leiomyoma, the efficacy and safety of HIFU are deeply studied, among which the hysteromyoma is large. The effect of HIFU on the treatment of uterine myoma is not clear. The purpose of this study is to study the difference between the efficacy and safety of HIFU in the treatment of different sizes of uterine leiomyoma, and to provide a theoretical basis for the screening and prognosis of HIFU for the treatment of uterine myoma. Methods: this study chose the standard of admission from February 2016 to December 2016 in the center of Suining, Sichuan province. 120 patients with single uterine myoma with high intensity ultrasound focused therapy were divided into 4 groups according to the maximum diameter D of myoma, 30 cases (1cm < d3cm), 30 cases of second (3cm < d5cm), 30 cases (5cm < d7cm), fourth group (d > 7cm) 30 cases, including the immediate volume ablation rate, and 1 after treatment by contrast HIFU. Months, March, follow-up of myoma reduction, the use of uterine leiomyoma symptom severity scale (UFS) to evaluate the symptoms of uterine myoma in March after treatment, as well as the treatment and treatment of adverse reactions and complications after treatment, analysis and evaluation of the clinical efficacy and safety of the four groups of patients treated with HIFU treatment, to further guide clinical practice and optimize the treatment of treatment. Methods to provide an objective theoretical basis for the prediction of therapeutic effect. Results: 1. the general clinical data of the four groups, including age, BMI, abdominal wall thickness, deep distance from the myoma to the sacral distance, the MRIT2 signal, the location and type of the myoma, were not significantly different. There was a comparable (P0.05).2.HIFU treatment of dosimetry parameters, and there was no significant difference in the treatment power between the four groups (P0.05). The irradiation time, the treatment intensity and the total energy were 22, and there was a difference between each group (P0.05). With the increase of the diameter of the myoma, the irradiation time, the intensity of treatment and the total energy increased gradually.3. all the patients successfully completed the HIFU treatment. The immediate volume ablation rate (%) obtained in each group was 86 + 12.50,87.91 + 7.92,86.52 + 10.06,87.79 + 10.12 respectively. The hysteromyoma reduction rate (%) in the four group of.4. four groups in January was 36.59 + 15.74,38.73 + 19.22,34.84 + 14.82,33.66 + 19.66 respectively, and 53.64 + 8.80,56.99 + 17.61,54.06 + 22.18 after operation, respectively. There was no significant difference between the groups (P0.05) in 120 cases of HIFU treatment (P0.05). 93 patients with symptomatic hysteromyoma were followed up in March. 90 patients were followed up in March. The scores of the patients were lower than those before the operation. The postoperative score was significantly lower than the preoperative score (P0.01). There was no significant difference (P0.05) in the four groups. The adverse reactions of the patients in the.6. operation were sacrococcygeal, abdominal, groin and hip pain. Pain, radiation pain, skin perm, no significant difference in the incidence of adverse reactions in comparison (P0.05). Follow up HIFU postoperative adverse reactions, including lower abdominal pain, fever, sacrococcygeal pain, vaginal discharge, skin injury, the incidence of lower abdominal pain and pain is the highest, and first, second, three groups of patients are lower than the fourth groups (P0.05), remaining (P0.05). There was no significant difference in the incidence of adverse reactions between each group. According to the SIR classification, the postoperative adverse reactions were all SIRA-B mild adverse reactions, and there was no significant difference (P0.05). Conclusion: 1. the greater the diameter of the uterine myoma, the higher intensity ultrasound focusing treatment of uterine myoma, the more radiation time, the total energy, but the size of the myoma is not a shadow. The short-term efficacy and safety of HIFU therapy can be used safely and effectively for the treatment of various sizes of uterine leiomyoma, especially for patients with the maximum diameter 7cm of myoma, which can be used as a safe and effective treatment.
【学位授予单位】：福建中医药大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R737.33

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