超声引导经皮微波消融治疗不同类型子宫肌瘤的安全性及疗效分析

发布时间：2018-07-03 14:01

本文选题：超声检查 + 介入性　；参考：《中国人民解放军医学院》2014年硕士论文

【摘要】：1目的研究超声引导经皮微波消融治疗不同类型子宫肌瘤的安全性及疗效。 2资料与方法2010年2月～2014年2月，在解放军总医院介入超声科接受超声引导经皮微波消融治疗的症状性子宫肌瘤患者，根据纳入及剔除标准筛选后，入组本研究者共150例,肌瘤150枚，患者年龄30～44岁，平均（30.5±5.2）岁，肌瘤直径3.3cm～12.5cm，平均（6.0±1.9）cm。依据不同标准将肌瘤分组1）根据治疗前盆腔CE-MRI，将肌瘤按FIGO分型归为三类：黏膜下（0～2型）；肌壁间（3～4型）；浆膜下（5～6型）；2）根据治疗前盆腔CE-MRI，将肌瘤按位置分成五种类型：前壁；后壁；宫底；侧壁；宫颈；3）根据瘤体均径d将肌瘤分三种：小肌瘤：d＜5cm；中等大小肌瘤：5cm≤d＜8cm；大肌瘤：d≥8cm。结果分析：①安全性分析：依据国际介入放射治疗协会针对介入治疗后不良反应及并发症制定的SIR分级评估法，将患者消融后出现的不良反应或并发症分为A～F共6个等级，其中无任何不良反应及A、B两级不良反应，这三种情况均视为治疗安全，C、D级视为欠安全，E、F级视为不安全。1）分析治疗的安全性；2）分析不同类型、不同位置、不同大小、不同消融率的肌瘤治疗安全性有无差异。②临床疗效分析：通过比较治疗前与治疗后2年内各种指标的变化情况，分析该技术的临床疗效。本研究根据国际肿瘤治疗UICC标准，拟定疗效评价标准：有效为瘤体缩小，FSR≥25%，临床症状及生活质量恢复至正常人水平或改善；无效为瘤体缩小，但FSR＜25%，临床症状无明显变化或严重。1）指标变化分析：肌瘤体积缩小率，临床症状及生活质量问卷评分，患者贫血情况；2）疗效分析；3）分析不同类型、不同位置、不同大小疗效差异；4）肌瘤复发率。 3结果第一章:安全性分析 1.1一般情况：黏膜下肌瘤28枚（0型6枚，1型10枚，2型12枚），肌壁间72枚（3型27枚，，4型45枚），浆膜下50枚（5型27枚，6型23枚）；前壁肌瘤50枚，后壁48枚，宫底33枚，侧壁16枚，宫颈3枚；小肌瘤48枚，中等大小肌瘤83枚，大肌瘤19枚。 1.2安全性：150例患者全部顺利完成消融，生命体征平稳。超声引导经皮微波消融治疗症状性子宫肌瘤安全性为98.7%。 1.3治疗后不良反应发生情况：150例患者治疗后，148例患者为无任何不良反应或为SIRA、B级不良反应，2例患者为SIR C级。 1.4不同类型、不同位置、不同大小的子宫肌瘤之间SIR分级差异均无显著性意义(P＞0.05)，消融率的高低与不良反应的SIR分级无明显关系。第二章:疗效分析 2.1随访基本情况：本组患者随访3～24个月，中位随访时间12.5个月，平均（12.84±9.44）个月；治疗后3、6、12及24个月随访患者分别为：131例，125例，121例及82例。 2.2疗效情况：消融后第3、6、12和24个月治疗后有效率分别为99.24%，99.20%，98.35%及98.78%；不同类型肌瘤相互比较，疗效无差异。 2.3肌瘤体积缩小率：消融后第3、6、12和24个月，肌瘤体积缩小率分别为69.0%，82.9%，88.0%及91.1%，其中黏膜下肌瘤体积缩小最为显著。 2.4贫血患者改善情况：治疗后6个月时，除2例复发患者，其余贫血患者全部改善。 2.5患者临床症状及生活质量问卷评分：消融后第3、6、12和24月时的SSS及HRQL与消融前相比,差异均有统计学意义。其中消融后3～6个月临床症状及生活质量可恢复至正常人水平，消融后6～24个月维持在该水平无明显变化；消融后3个月时黏膜下肌瘤SSS变化最明显，其余时间各种类型肌瘤相比SSS及HRQL变化情况无显著差异。 2.64年内肌瘤复发率：2例患者治疗后肌瘤复发。 4结论 1．超声引导经皮微波消融能安全治疗各种类型的子宫肌瘤；不良反应的发生情况与肌瘤的类型、位置、大小、消融率无关； 2．超声引导经皮微波消融能有效缩小肌瘤体积，其中黏膜下肌瘤体积缩小最显著；随着瘤体缩小，患者临床症状及生活质量可在3～6个月内恢复至正常人水且并可长期维持；患者临床症状改善情况与肌瘤类型无明显关系。
[Abstract]:1 Objective To study the safety and efficacy of ultrasound-guided percutaneous microwave ablation for different types of uterine fibroids.
2 data and methods from February 2010 to February 2014, the patients with symptomatic uterine fibroids were treated by ultrasound guided percutaneous microwave ablation in the General Hospital of the PLA General Hospital. After the inclusion and elimination of the standard screening, 150 cases were enrolled in the group and 150 myoma, the patients were 30~44 years old, with an average of (30.5 + 5.2) years, the diameter of the myoma was 3.3cm to 12.5cm. The average (6 + 1.9) cm. was grouped in the myoma according to the different standards according to the different standards. According to the pre treatment pelvic CE-MRI, the myoma was classified into three categories according to the FIGO type: submucosal (0~2 type); the muscle wall (type 3~4); subserous (type 5~6); 2) divided into five types according to the anterior pelvic CE-MRI; the anterior wall; the posterior wall; the lateral wall; cervix. (3) 3) the myoma was divided into three types according to the average diameter of the tumor: small myoma: d < 5cm; medium size myoma: 5cm < d < 8cm; large myoma: analysis of d > 8cm. results: (1) safety analysis: according to the SIR grading assessment for adverse reactions and complications after interventional therapy, the occurrence of patients after ablation is not Good reactions or complications were divided into 6 grades A to F. There were no adverse reactions and A, B two adverse reactions. These three conditions were considered as the safety of treatment, C, D, E, F as unsafe.1) analysis of the safety of treatment; 2) analysis of the safety of different types, different positions, different sizes, and different ablation rates. No difference. (2) clinical efficacy analysis: the clinical efficacy of this technique was analyzed by comparing the changes of various indexes before and after 2 years after treatment. According to the UICC standard of international tumor treatment, this study drew up the standard of evaluation of curative effect: reducing the tumor body, FSR more than 25%, the clinical symptoms and the quality of life recovered to the normal level or improvement; Ineffective tumor size, but FSR < 25%, clinical symptoms without obvious changes or serious.1) index changes: myoma volume reduction, clinical symptoms and quality of life questionnaire score, patient anemia; 2) curative effect analysis; 3) analysis of different types, different positions, different size effect difference; 4) the recurrence rate of myoma.
3 Results
Chapter 1: Security Analysis
1.1 general situation: submucous myoma 28 (0 type 6, 1 type 10, 2 type 12), 72 of muscle wall (3 27, 4 45), anterior wall myoma, posterior wall, lateral wall, cervical spine, small myoma, medium myoma and myoma.
1.2 safety: 150 patients were successfully completed ablation and vital signs were stable. The safety of ultrasound-guided percutaneous microwave ablation for symptomatic uterine fibroids was 98.7%.
1.3 adverse reactions after treatment: 150 patients after treatment, 148 patients without any adverse reactions or SIRA, grade B adverse reactions, 2 patients were SIR C grade.
1.4 there was no significant difference in SIR classification between different types, different positions and different sizes of uterine leiomyoma (P > 0.05), and there was no significant relationship between the ablation rate and the SIR classification of adverse reactions.
The second chapter: analysis of curative effect
2.1 the basic situation of follow-up: the patients were followed up for 3~24 months, the median follow-up time was 12.5 months (12.84 + 9.44 months), and the patients were followed up for 3,6,12 and 24 months after treatment: 131 cases, 125 cases, 121 cases and 82 cases.
2.2 curative effect: after 3,6,12 and 24 months after ablation, the effective rate was 99.24%, 99.20%, 98.35% and 98.78%, and the different types of myoma were compared with each other, and the curative effect was no difference.
The volume reduction rate of 2.3 myoma: the volume reduction rate of myoma was 69%, 82.9%, 88% and 91.1% respectively at 3,6,12 and 24 months after ablation, and the most significant reduction in submucous myoma was the reduction of the volume of myoma.
2.4 anemia patients improvement: 6 months after treatment, in addition to 2 patients with relapse, all the other anemia patients improved.
2.5 patients' clinical symptoms and quality of life questionnaire score: SSS and HRQL at 3,6,12 and 24 months after ablation were statistically significant compared with that before ablation. In 3~6 months after ablation, the clinical symptoms and quality of life could be restored to normal level, and there was no significant change at this level for 6~24 months after ablation; and 3 months after ablation. SSS changes were most obvious in submucous myoma. There was no significant difference in SSS and HRQL in different types of myoma at other times.
Recurrence rate of myoma in 2.64 years: 2 patients relapsed after treatment.
4 Conclusion
1. ultrasound guided percutaneous microwave ablation can safely treat various types of myoma of uterus. The occurrence of adverse reactions is not related to the type, location, size, and ablation rate of the myoma.
2. ultrasound guided percutaneous microwave ablation can effectively reduce the volume of myoma, in which submucous myoma has the most significant reduction in volume. With the reduction of the tumor body, the clinical symptoms and quality of life can be recovered to normal human water within 3~6 months and can be maintained for a long time. The improvement of the clinical symptoms of the patients has no significant relationship with the type of myoma.
【学位授予单位】：中国人民解放军医学院
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R445.1;R737.33

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