超声消融治疗多发性子宫肌瘤的影响因素研究

发布时间：2018-12-11 02:52

【摘要】：研究背景：子宫肌瘤是育龄期女性最常见疾病，约占妇科良性肿瘤的52%。目前其发病机制尚不完全清楚，但与雌激素相关。肌瘤一般多发，以肌壁间最常见，其临床表现与肌瘤类型、肌瘤数目、肌瘤大小等相关，常见症状为经量增多、经期延长、尿频尿急、贫血、下腹坠胀等，但多数患者无症状，常经体检发现。目前治疗子宫肌瘤的方法主要包括药物治疗、手术治疗及其他治疗。对于无症状的患者，可选择期待疗法，定期随访，部分子宫肌瘤患者也能自然怀孕。近年来超声消融治疗作为一种非侵入性、保守性治疗子宫肌瘤的方法已取得满意的临床疗效。本实验通过研究超声消融对多发性子宫肌瘤的治疗情况及可行性，分析影响多发性子宫肌瘤能否消融及消融率的相关因素。 目的：探讨影响超声消融治疗多发性子宫肌瘤的因素。 方法：对32例多发性子宫肌瘤患者进行一次性超声消融治疗，同时记录患者术中反应。术后第二天所有患者均行盆腔MRI平扫+增强检查，计算未消融肌瘤的个数，统计未消融肌瘤未能治疗的原因，分析肌瘤能否消融与肌瘤大小、位置、类型及T2WI信号的关系。分析消融率与肌瘤大小、位置、类型及T2WI信号的关系。 结果：（1）32例多发性子宫肌瘤患者均顺利完成超声消融治疗，术中均发生不适反应，但无需治疗，，无不良后果。 （2）肌瘤消融情况分析：消融前MRI检查显示32例患者最大径≥10mm肌瘤共123个，术后增强MRI显示其中91个肌瘤完全或部分无强化。肌瘤类型、位置及MRI T2WI信号与肌瘤能否消融无统计学意义（P＞0.05），肌瘤大小与肌瘤能否消融有统计学意义（P＜0.05）。 （3）消融肌瘤消融率28.6~100%，平均消融率（88.27±14.68）%。比较发现不同大小、类型及位置的肌瘤之间消融疗效差异无统计学意义（P＞0.05），在MRI T2WI上不同信号的肌瘤消融疗效差异有统计学意义（P＜0.05），T2WI低信号的肌瘤消融率最高。 结论：超声消融治疗多发性子宫肌瘤是一种安全、可行的无创方法，影响多发性子宫肌瘤能否消融的主要因素是肌瘤的大小。肌瘤消融率与肌瘤在MRI T2WI上不同信号相关。
[Abstract]:Background: uterine leiomyoma is the most common disease in women of childbearing age, accounting for 52% of benign gynecological tumors. At present, its pathogenesis is not completely clear, but it is related to estrogen. The clinical manifestations of myoma are related to the type of myoma, the number of myoma, the size of myoma, etc. The common symptoms are increased volume, prolonged menstrual period, frequent urination, anemia, abdominal distension and so on, but most patients are asymptomatic. It is often found by physical examination. Current treatments for uterine leiomyoma include drug therapy, surgical treatment and other treatments. For asymptomatic patients, you can choose expectant therapy, regular follow-up, some uterine fibroids can also be naturally pregnant. In recent years, ultrasound ablation as a non-invasive, conservative treatment of uterine leiomyoma has achieved satisfactory clinical results. In this study, we studied the feasibility of ultrasound ablation for multiple uterine leiomyoma, and analyzed the factors influencing the ablation rate of multiple uterine leiomyoma. Objective: to investigate the factors influencing ultrasound ablation for multiple uterine leiomyoma. Methods: 32 patients with multiple hysteromyoma were treated by one-time ultrasound ablation and the intraoperative reaction was recorded. On the second day after operation, all patients were examined by plain enhanced pelvic MRI, the number of unablated leiomyomas was calculated, the causes of unablated leiomyoma were counted, and the relationship between ablation and size, location, type and T2WI signal of leiomyoma was analyzed. To analyze the relationship between ablation rate and size, location, type and T2WI signal of leiomyoma. Results: (1) 32 patients with multiple uterine leiomyoma successfully completed ultrasound ablation. (2) Analysis of ablation status of leiomyoma: before ablation, MRI examination showed that there were 123 cases of myoma with maximum diameter 鈮

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