HIFU治疗育龄期子宫腺肌病的作用评价

发布时间：2018-07-18 15:04

【摘要】：子宫腺肌病是由于子宫内膜的腺体和间质侵入子宫肌层时所致，多发生于育龄期女性，其主要临床症状为经量增多、进行性痛经、继发性不孕，发病率从8.8%～31.0%不等[1]。子宫腺肌病治疗方法有传统的手术、药物治疗及近年来发展迅速的非侵入性治疗。手术治疗方式包括子宫切除术、腺肌病病灶切除术。临床常用药物有促性腺激素释放激素激动剂、雄激素类衍生物、孕激素类和米非司酮等。非侵入性治疗则为超声或磁共振引导下高强度聚焦超声（HIFU）消融治疗。子宫腺肌病所致的经量增多、痛经等症状以及其所引起继发性不孕对育龄期患者的生活质量造成重大影响，HIFU作为一项非侵入性治疗，已逐渐为医生和病人所熟悉，，我们希望通过分析育龄期子宫腺肌病患者HIFU治疗后疗效随访，探讨该项技术对于缓解由育龄期子宫腺肌病所引起的临床症状的有效性，从而得出HIFU治疗育龄期子宫腺肌病的可行性。磁共振成像(MRI)对子宫腺肌病的诊断率达100%，能够准确定位病灶部位、范围[2]，可用于测量子宫与病灶的体积；靶治疗区在HIFU治疗后出现的非灌注区体积也可通过术后即刻的盆腔增强MRI得以计算。故而盆腔增强MRI可用于评价子宫腺肌病的消融效果。通过随访子宫腺肌病的消融效果及临床症状缓解效果，可以得出HIFU治疗该疾病是否有效的结论，帮助医生和患者更好地进行选择适合的治疗方式。目的：回顾性分析HIFU治疗育龄期子宫腺肌病症状改善情况，评价HIFU治疗育龄期子宫腺肌病的安全性及有效性。方法：收集重庆医科大学附属第一医院2010年7月至2012年2月期间诊断为子宫腺肌病且处于育龄期（年龄18~39岁）的49例患者，采用JC型聚焦超声肿瘤治疗系统进行治疗，以实时超声灰度改变即刻评价治疗效果；术后以盆腔增强MRI评价HIFU消融情况；并于HIFU治疗后1、3、6、12、24个月进行随访，评价患者痛经症状及月经量改善情况；根据国际介入放射治疗协会制定的SIR分类法评价治疗的安全性。结果：49例患者均完成HIFU治疗，治疗过程中监控超声评价，79.6%有团块状灰度变化；HIFU治疗后增强MRI计算腺肌病病灶平均消融率为（76.6±10.1）%；治疗后1、3、6、12、24个月，月经量增多缓解有效率分别为63.3%、65.7%、67.9%、77.8%、80.0%；痛经症状缓解有效率分别为91.1%、91.0%、93.0%、92.7%、75.0%；所有病例均无严重不良反应发生，SIR分类A级41例，B级5例，C~F级0例；8例治疗后3月到2年内怀孕，其中5例顺利产子。结论：HIFU治疗育龄期子宫腺肌病安全有效。
[Abstract]:Adenomyosis is caused by the invasion of endometrial glands and stroma into the myometrium and occurs mostly in women of childbearing age. Its main clinical symptoms are increased menstrual volume, progressive dysmenorrhea, secondary infertility, the incidence of which ranges from 8.81.0% to 31.0% [1]. The treatment methods of adenomyosis include traditional surgery, drug therapy and non-invasive treatment which has developed rapidly in recent years. Surgical treatment includes hysterectomy, adenomyosis focus resection. Commonly used drugs are gonadotropin releasing hormone agonists androgen derivatives progesterone and mifepristone. Non-invasive treatment was guided by ultrasound or magnetic resonance-guided high-intensity focused ultrasound (HIFU) ablation. The increased amount of menstruation caused by adenomyosis, dysmenorrhea and its secondary infertility have had a significant impact on the quality of life of patients of childbearing age. As a non-invasive treatment, HIFU has gradually become familiar to doctors and patients. We hope to investigate the efficacy of HIFU in relieving the clinical symptoms caused by adenomyosis of childbearing age by analyzing the effect of HIFU treatment on patients with adenomyosis of childbearing age. The feasibility of HIFU in the treatment of adenomyosis at childbearing age was obtained. The diagnostic rate of magnetic resonance imaging (MRI) for adenomyosis is 100, and it can accurately locate the location of the lesion [2], which can be used to measure the volume of uterus and lesion. The volume of non-perfusion area in target treatment area after HIFU treatment can also be calculated by pelvic enhanced MRI immediately after operation. Therefore, enhanced pelvic MRI can be used to evaluate the ablation effect of adenomyosis. By following up the ablation effect of adenomyosis and the relief effect of clinical symptoms, we can draw the conclusion that HIFU is effective in the treatment of this disease, and help doctors and patients to choose the appropriate treatment better. Objective: to evaluate the safety and efficacy of HIFU in the treatment of reproductive adenomyosis. Methods: 49 patients with adenomyosis diagnosed in the first affiliated Hospital of Chongqing Medical University from July 2010 to February 2012 were treated with JC focused ultrasound tumor therapy system. The effect of HIFU ablation was evaluated immediately by real-time ultrasound gray scale change, the ablation of HIFU was evaluated by pelvic enhanced MRI, and the symptoms of dysmenorrhea and the improvement of menstrual volume were evaluated at 12 and 24 months after HIFU treatment. Safety was evaluated according to Sir classification developed by the International Association for Interventional radiotherapy. Results all 49 cases of adenomyosis were treated with HIFU. The mean ablation rate of adenomyosis was (76.6 卤10.1) calculated by enhanced MRI after HIFU treatment, and the mean ablation rate was (76.6 卤10.1) after HIFU treatment, and 612,12 months after treatment, 24 months after HIFU treatment. The effective rates for relief of increased menstrual volume were 63.3% and 65.7%, 67.9% and 77.8%, respectively; the effective rates for relief of dysmenorrhea were 91.1% and 91.0%, 93.0%, 92.7% and 75.0%, respectively. There were no serious adverse reactions in all cases. There were 41 cases of grade A and 5 cases of grade C F grade B with severe adverse reactions. 8 cases were pregnant within 3 months to 2 years after treatment. Among them, 5 cases gave birth successfully. Conclusion it is safe and effective to treat adenomyosis of childbearing age with HIFU.
【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】：R711.71

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