超声消融子宫肌瘤的影响因素分析及脂肪、肌肉对HIFU能量的影响

发布时间：2018-11-15 10:27

【摘要】：研究背景：子宫肌瘤是妇科常见病、多发病，，起源于子宫平滑肌细胞，发病原因尚不明确。子宫肌瘤可引起诸多临床症状，如子宫异常出血、盆腔压迫症状、流产和不孕等。高强度聚焦超声（HIFU）是一种无创热消融技术，近十几年来在妇科临床应用中发展迅速。它通过将超声能量聚焦于靶肌瘤形成凝固性坏死，达到原位切除的目的。其安全性、有效性已得到证实，展示了广阔的应用前景。随着HIFU消融子宫肌瘤的临床方案及剂量学研究的进步，超声消融子宫肌瘤的消融率有所提高、治疗时间也有所缩短，尤其部分T2WI高信号或T1WI增强程度高的肌瘤已能达到满意消融率。故目前哪些因素才是影响消融效果的重要因素仍值得探讨。目的： 1.通过单因素相关性分析，研究多种因素对HIFU消融子宫肌瘤消融率、消融效率的影响。 2.比较高强度聚焦超声通过不同厚度脂肪及肌肉组织消融猪肉内靶点时的能量衰减情况。资料和方法： 1.对63例子宫肌瘤患者（76个肌瘤）进行1次性HIFU治疗。治疗前及治疗后3天内行盆腔MRI平扫及增强检查，按照肌瘤类型、部位、最大径、靶皮距、T2WI信号、T1WI增强程度、治疗强度进行分组，在每一组内不同水平之间分别行消融率、消融效率的比较。 2.在MRI监控下分别选择脂肪厚度为0mm、20mm、28mm的猪肉内靶点，以输出功率200W、辐照时间10s进行单点消融，比较相同辐照条件下所产生的凝固性坏死体积。进一步选择脂肪厚度25mm的带皮猪肉，将焦点置于距肌肉表面深度20mm、30mm的靶点进行单点辐照，比较相同脂肪厚度不同肌肉厚度时凝固性坏死发生情况；再选择无皮和脂肪的猪肉，将焦点置于距肌肉表面20mm、30mm进行单点消融，比较不同肌肉厚度时凝固性坏死发生情况。结果： 1.消融率≥70%的子宫肌瘤比例超过65%，消融效率≥50mm3/s的肌瘤比例超过56%。前壁肌瘤、子宫前位的宫底部肌瘤以及治疗中超声能量不通过一侧正常子宫肌壁的侧壁肌瘤消融率高于后壁肌瘤、子宫后位的宫底部肌瘤以及治疗中超声能量通过一侧正常子宫肌壁的侧壁肌瘤（P＜0.05）；T1WI增强程度低、中、高三组间的消融率差异有统计学意义（P＜0.05）；而肌瘤的类型、最大径、靶皮距、T2WI信号、治疗强度对消融率的影响均无统计学意义(P＞0.05)。最大径＜5cm、≥5cm的肌瘤之间比较以及T1WI增强程度低、中、高三组间比较，消融效率差异均具有统计学意义（P＜0.05）；而肌瘤的类型、部位、靶皮距、T2WI信号、治疗强度对消融效率的影响均无统计学意义(P＞0.05)。 2.随着脂肪厚度的增加，相同辐照条件下产生凝固性坏死区体积逐渐缩小；同时随脂肪厚度的增加，凝固性坏死区纵径逐渐增加，而横径逐渐缩小。当辐照无脂肪的猪肉组织时，随肌肉厚度的增加，损伤体积缩小。但相同厚度的脂肪组织对超声能量的衰减大于肌肉组织。结论： 1.子宫肌瘤的部位、T1WI增强程度对消融率有显著影响，肌瘤的大小、T1WI增强程度对消融效率有显著影响。 2.高强度聚焦超声通过离体脂肪组织、肌肉组织时均有能量衰减；脂肪组织对超声能量的衰减程度高于肌肉组织。
[Abstract]:Study Background: Hysteromyoma is a common disease of the gynaecology. It is a common disease of the uterus. It is originated from the smooth muscle cells of the uterus. The cause of the disease is not yet It is clear that uterine fibroids can cause many clinical symptoms, such as abnormal uterine bleeding, pelvic compression, abortion, and no High-intensity focused ultrasound (HIFU), a non-invasive thermal ablation technique, has been developed in the clinical application of gynecology for more than a decade. Rapid. It is achieved in situ by focusing the ultrasound energy on the target myomas to form a coagulation necrosis. Objective. The safety and effectiveness of the method have been proved, and the wide application is shown. With the progress of the clinical and dosimetry of the HIFU ablation of the uterine fibroids, the ablation rate of the ultrasonic ablation of the uterine fibroids is improved, and the treatment time is also shortened. In particular, the high signal of the T2WI or the high degree of enhancement of the T1WI can be achieved. The rate of ablation is satisfactory. So what factors are the most important factors that affect the effect of the ablation still worth Objective: To study the effect of multiple factors on the ablation of uterine fibroids by single factor correlation analysis. Effects of ablation rate and ablation efficiency. Comparison of high intensity focused ultrasound through different thickness of fat and muscle tissue pork-in-pork target Energy attenuation at the time of time. Materials and methods: 1. 63 cases of hysteromyoma Patients (76 myomas) underwent a primary HIFU treatment. Pelvic MRI plain scan and enhanced examinations were performed within 3 days prior to and after treatment, grouped by type of myoma, site, maximum diameter, target skin distance, T2WI signal, T1WI enhancement, treatment intensity, in each group The ablation rate and the ablation efficiency were compared between different levels. The target of the pork with the fat thickness of 0mm, 20mm and 28mm were selected under the control of MRI, and the output power 200W and the irradiation time 10s were single-point. Radiofrequency ablation was performed to compare the volume of coagulative necrosis produced under the same irradiation conditions. The skin pork with a fat thickness of 25 mm was further selected, and the focal point was placed on a target spot with a depth of 20 mm and 30 mm from the surface of the muscle, and a single point irradiation was performed to compare the occurrence of the coagulation necrosis when the same fat thickness was different from the thickness of the muscle; and then, No skin and fat pork, focus on the muscle surface 20mm, 30mm single point elimination The results were as follows: 1. The rate of ablation was lower than 70%. In the case of more than 65%, the proportion of myomectomy with ablation efficiency of 50mm3/ s was more than 56%. The myoma of the anterior wall, the uterine leiomyoma of the anterior position of the uterus and the ultrasonic energy in the treatment did not pass through the side wall of the normal uterine muscle wall on one side, and the ablation rate was higher than that of the posterior wall myoma, the hysteromyoma at the posterior position of the uterus, and the treatment. There was a significant difference in the ablation rate among the three groups (P <0.05), and the type of the myoma, the maximum diameter, the target skin distance, the T2WI, and the contrast between the three groups were statistically significant (P <0.05). The effect of the signal and treatment intensity on the ablation rate was not statistically significant (P> 0.05). The maximum diameter was <5cm, and the difference of the ablation efficiency was statistically significant between the three groups. (P <0.05); and the type, location, target skin distance and T2WI of the myoma The effect of the treatment intensity on the ablation efficiency was not statistically significant (P> 0.05). At the same time, with the increase of the fat thickness, the longitudinal diameter of the coagulative necrosis area is gradually increased, and the transverse diameter is gradually increased. tapering. When the fat-free pork tissue is irradiated, the thickness of the muscle increases with the thickness of the muscle, damage The volume is reduced, but the attenuation of the ultrasound energy by the same thickness of adipose tissue is greater than that of the muscle tissue. Conclusion: 1. The site of the hysteromyoma, T1WI the degree of enhancement had a significant effect on the ablation rate, the size of the myoma, the degree of enhancement of T1WI, and the ablation efficiency.
【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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