子宫肌瘤血流灌注定量参数预测超声消融效果的价值

发布时间：2018-06-01 13:07

本文选题：子宫肌瘤 + 高强度聚焦超声　；参考：《重庆医科大学》2017年硕士论文

【摘要】：子宫肌瘤是常见的妇科疾病,为平滑肌细胞良性增生所致,可引起女性经量增多、盆腔压迫、不孕、贫血等症状,严重影响女性的身心健康。子宫全切除术被公认为是根治子宫肌瘤的方式,但该手术对女性生理上及心理上均有较大影响,且不适合有保留生育愿望的患者。子宫肌瘤剔除术有术后复发、瘢痕子宫及妊娠期子宫破裂的风险。高强度聚焦超声(High Intensity Focused Ultrasound,HIFU)作为一种完全非侵入性肿瘤热消融技术,具有并发症少、治疗后恢复快、保留器官完整性等优点,已越来越多应用于子宫肌瘤的治疗。大量临床研究表明HIFU可显著缩小肌瘤体积,缓解经量多、贫血等相关症状。热效应是HIFU治疗的主要机制,肌瘤的血流灌注是影响超声能量热沉积的重要因素,因此HIFU术前了解子宫肌瘤的血流灌注特征对于超声消融治疗子宫肌瘤具有重要意义。超声造影(Contrast-enhanced Ultrasound,CEUS),是目前临床中常用的评价血流灌注的方法,其所使用的超声造影剂(Ultrasound Contrast Agent,UCA)是由脂质包裹的氟化碳气体形成的微气泡,该微泡在体内血流动力特征与红细胞相似,可通过毛细血管而不进入组织间隙,是一种良好的血管显像剂。本研究旨通过术前对子宫肌瘤进行造影检查定量评价子宫肌瘤血流灌注特征,探讨与hifu消融效果的关系及其对预测超声消融效果的价值。目的通过分析超声造影定量参数与消融效果的关系以及探索定量参数对预测超声消融效果的价值,为临床超声消融治疗子宫肌瘤临床方案制定提供帮助。方法对63例子宫肌瘤患者术前行超声造影检查,采用jc型超声消融治疗系统内置灰度测量软件获得子宫肌瘤血流灌注定量参数。术后根据增强mri将消融结果分为消融满意组(消融率≥70%)和部分消融组(消融率70%),比较两组造影参数差异,分析造影参数与消融率的关系,并采用受试者工作特征曲线(roc)评价造影参数对消融效果的预测价值。结果部分消融组造影剂注射后的始增时间(at)、峰值时间(pt)、增强时间(et)分别为(13.20±4.09)s、(20.86±5.38)s、(7.66±2.19)s,明显快于消融满意组的(16.77±3.50)s、(26.95±4.98)s、(10.18±2.58)s;部分消融组的增强强度值(ei)、增强速率值(er)分别为(62.44±27.86)、(8.54±4.56),明显高于消融满意组的(29.77±16.72)、(3.02±1.67)。相关性分析显示:at、pt、et与消融率呈正相关(p0.01),ei、er与消融率呈负相关(p0.01),其中与er相关性最大(r=-0.724)。at、pt、et、ei、er作为预测指标的roc曲线下面积(auc)分别为0.806、0.820、0.767、0.841、0.935,对应预测消融效果满意的最佳截点值分别为AT13.50s、PT20.50s、ET9.50s、EI34.55、ER5.23。结论1.在不同HIFU消融效果间,超声造影参数存在显著差异:部分消融组在始增时间、峰值时间、增强时间方面明显快于消融满意组,在增强强度、增强速率方面明显大于消融满意组。2.超声造影定量参数与消融率存在相关性,始增时间、峰值时间、增强时间与消融率呈正相关,增强强度、增强速率与消融率呈负相关。增强速率与消融率相关性最高。3.子宫肌瘤超声造影定量参数可用于预测HIFU消融效果,其中增强速率预测准确率较高。增强速率越慢,预示着消融效果越好,增强速率可作为预测HIFU效果的良好指标。
[Abstract]:Uterine myoma is a common gynecologic disease. It is caused by benign hyperplasia of smooth muscle cells. It can cause the increase of female, pelvic oppression, infertility, anemia and other symptoms, which seriously affect the physical and mental health of women. Hysterectomy is generally accepted as a way of radical hysteromyoma, but the operation has great influence on women's physiology and psychology. It is not suitable for patients with the desire to retain fertility. Uterine myomectomy has the risk of postoperative recurrence, scar uterus and pregnancy uterine rupture. High Intensity Focused Ultrasound (HIFU) is a complete noninvasive tumor heat ablation technique with fewer complications, rapid recovery after treatment, and preservation of organ integrity. A large number of clinical studies have shown that HIFU can significantly reduce the volume of myoma, alleviate the excess volume, and anemia and other related symptoms. The thermal effect is the main mechanism of HIFU treatment. The blood flow perfusion of myoma is an important factor affecting the ultrasonic energy thermal deposition. Therefore, the blood flow irrigation of myoma of uterus is understood before HIFU. The injection characteristics are of great significance for the treatment of uterine myoma by ultrasonic ablation. Contrast-enhanced Ultrasound (CEUS) is a common method to evaluate blood flow in the clinic. The ultrasound contrast agent (Ultrasound Contrast Agent, UCA) is a microbubble formed by the lipid encapsulated fluorocarbon gas, and the microbubble is in body. The internal hemodynamic characteristics are similar to those of red blood cells, which can be a good vascular imaging agent through capillaries without entering the tissue space. This study aims to quantitatively evaluate the blood flow characteristics of uterine myoma by contrast examination of uterine myoma before operation, and to explore the relationship with the effect of HIFU ablation and its value for predicting the effect of ultrasound ablation. Objective to analyze the relationship between the quantitative parameters of ultrasound contrast and the effect of ablation, and to explore the value of quantitative parameters to predict the effect of ultrasonic ablation, and to provide help for the clinical scheme formulation of clinical ultrasound ablation in the treatment of uterine myoma. Methods 63 cases of hysteromyoma were examined by ultrasound contrast, and the JC ultrasound ablation treatment system was built in. The quantitative parameters of uterine myoma were obtained by the gray scale measurement software. The ablation results were divided into satisfactory ablation group (ablation rate > 70%) and partial ablation group (ablation rate 70%) after operation. The relationship between the parameters of the two groups was compared with the two groups, and the relationship between the contrast parameters and the ablation rate was analyzed, and the parameters of the subjects' work characteristic curve (ROC) were used to evaluate the contrast parameters. Results the initial time (at), peak time (PT) and enhanced time (ET) were (13.20 + 4.09) s, (20.86 + 5.38) s and (7.66 + 2.19) s, respectively, and (16.77 + 3.50) s, (26.95 + 4.98) s, (10.18 + 2.58) s, and enhanced strength (EI), enhancement (EI), enhanced speed of the ablation group. The rate (ER) was (62.44 + 27.86), (8.54 + 4.56), significantly higher than (29.77 + 16.72) of the ablation group (29.77 + 16.72), (3.02 + 1.67). Correlation analysis showed that at, Pt, et had a positive correlation with ablation rate (P0.01), EI, Er had a negative correlation with the ablation rate (P0.01). 0.806,0.820,0.767,0.841,0.935, the best points for the satisfactory results were AT13.50s, PT20.50s, ET9.50s, EI34.55, ER5.23.. Conclusion 1. in different HIFU ablation effects, there were significant differences in the parameters of ultrasound contrast: the time of initial increase, the peak time and the enhancement time were faster than that of the ablation satisfaction. The correlation between the quantitative parameters and the ablation rate of.2. ultrasound contrast was significantly greater in the enhancement and the enhancement rate than in the ablation satisfactory group. The initial increase time, the peak time, the enhancement time and the ablation rate were positively correlated, the enhancement and the rate of enhancement were negatively correlated with the ablation rate. The highest correlation between the enhancement rate and the ablation rate was.3. hysteromyoma ultrasound contrast. The quantitative parameters can be used to predict the effect of HIFU ablation, in which the accuracy of the enhancement rate is higher. The slower the enhancement rate is, the better the ablation effect is, the better the enhancement rate can be used as a good indicator of the prediction of the effect of 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】：2017
【分类号】：R737.33

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