影响超声消融子宫腺肌病疗效相关因素研究

发布时间：2018-08-08 17:48

【摘要】：高强度聚焦超声(High intensity focused ultrasound,HIFU)消融是近年新发展起来的一项非侵入性治疗技术。由于其创伤小、恢复快、疗效确切、可保留子宫等特点,在治疗子宫腺肌病的临床应用上日益广泛。HIFU消融治疗子宫腺肌病的原理是将体外低能量的超声波聚焦于腺肌病灶内,通过焦点处超声波产生的热能量使病灶发生不可逆性凝固性坏死,从而使异位的子宫内膜失去生长和出血功能,达到治疗目的同时而又不损伤靶区周围组织。随着临床研究的不断深入,在临床应用过程中发现,不同腺肌病灶对HIFU消融治疗的反应不一致,部分患者容易取得良好的消融率,也有部分患者消融效果欠佳,但其相关影响因素尚未明确。本文旨在通过大样本研究,从消融率、能效因子(EEF)、团块状强回声三个消融疗效指标综合分析影响超声消融子宫腺肌病疗效的因素。为HIFU治疗子宫腺肌病优化适应症、优化治疗方案提供依据。目的探讨影响HIFU治疗子宫腺肌病疗效的相关因素。材料和方法回顾性分析2011年1月至2014年7月重庆市海扶医院接受HIFU治疗的245例子宫腺肌病患者,所有患者在HIFU治疗前后均进行MRI增强扫描。分别将消融率、EEF及团块状强回声设定为因变量,可能影响消融疗效的因素设定为自变量建立多元回归模型。结果245例子宫腺肌病患者均一次性完成HIFU消融治疗。T1WI强化类型、腹壁厚度、腺肌病灶体积、高信号出血点数量、子宫位置、腺肌病灶位置与消融率存在线性相关性。病灶腹侧面到皮肤的距离、T1WI强化类型、腺肌病灶体积、腹壁厚度及T2WI信号强度与EEF存在线性相关性。子宫位置和腹壁厚度与团块状强回声的出现存在线性关系。结论T1WI强化类型、T2WI信号强度、腺肌病灶体积、子宫位置、腺肌病灶位置、高信号出血点数量、腹壁厚度、病灶腹侧面到皮肤的距离均可作为预测HIFU消融子宫腺肌病疗效的因素。
[Abstract]:High intensity focused ultrasound (High intensity focused) ablation is a newly developed noninvasive therapy technique. Because of its small trauma, quick recovery, accurate curative effect and so on, it can preserve the uterus and so on. The principle of HIFU ablation in the treatment of adenomyosis is to focus the low energy ultrasound on the adenomyosis in vitro. The thermal energy generated by ultrasonic at the focal point causes irreversible coagulation necrosis of the lesion, which causes ectopic endometrium to lose its function of growth and bleeding, and to achieve the purpose of treatment without damaging the surrounding tissues of the target area. With the development of clinical research, it was found that the response of different adenomyosis lesions to HIFU ablation was not consistent, some patients were easy to obtain a good ablation rate, and some patients had poor ablation effect. However, the related factors are not clear. The purpose of this study was to analyze the factors influencing the effect of ultrasound ablation on adenomyosis from the three indexes of ablation rate, energy efficiency factor (EEF),) block and strong echo. To provide the basis for the optimal indications and optimal treatment of HIFU for adenomyosis. Objective to investigate the factors influencing the efficacy of HIFU in the treatment of adenomyosis. Materials and methods from January 2011 to July 2014, 245 patients with adenomyosis treated with HIFU in Haifu Hospital of Chongqing City were retrospectively analyzed. All patients underwent MRI enhanced scanning before and after HIFU treatment. The EEF and mass echo were set as dependent variables, and the factors that might affect the ablation efficacy were set up as independent variables to establish a multivariate regression model. Results all patients with adenomyosis underwent HIFU ablation at one time. There was a linear correlation between the type of enhancement, the thickness of abdominal wall, the volume of adenomyosis, the number of hyperintense bleeding points, the location of uterus, the location of adenomyosis and the ablation rate. The distance from the ventral side to the skin on T 1WI enhancement type, the volume of adenomyoma, the thickness of abdominal wall and the intensity of T2WI signal were linearly correlated with EEF. There is a linear relationship between the location of uterus and the thickness of abdominal wall. Conclusion the intensity of T2WI signal intensity, the volume of adenomyosis, the location of uterus, the location of adenomyosis, the number of hyperintense bleeding points, the thickness of abdominal wall and the distance from the ventral side of the lesion to the skin can be used as predictors for the curative effect of HIFU ablation of adenomyosis.
【学位授予单位】：重庆医科大学
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R711.71

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