超声造影剂联合HIFU治疗不同直径子宫肌瘤的增效作用研究
发布时间：2018-11-02 18:10
【摘要】：研究背景:子宫肌瘤属于女性生殖系统疾病,多发于育龄期年龄阶段的女性,其发病原因尚未完全研究明确。子宫肌瘤的大小和生长部位很大程度上影响其临床症状,主要表现为经量增多、经期延长、周期不规律、下腹疼痛、盆腔压迫导致尿频等。高强度聚焦超声(HⅠgh IntensⅠty Focused Ultrasound,HIFU)这项近年来为临床提供一种可精确定位、没有皮肤切口的无创治疗方法,目前,已经广泛应用于乳腺、子宫、肝、肾、胰腺等各部位的良、恶性实体肿瘤的治疗[1]。HIFU是一种非侵入性的物理治疗手段,绝大多数患者术后创伤小,术后恢复叫有创手术快,同时也保留了自身的器官的完整性,以上的特点让HIFU技术慢慢的成为广大女性患者治疗子宫肌瘤的新选择。超声造影剂(Ultrasound contrast agent,UCA)是一类能够显著增强超声背向散射强度的化学制剂,其主要成分是微气泡,故我们也可简称其微泡。最早的超声造影剂是通过手振生理盐水获得,仅能显示右心系统显像,研究证明超声造影剂可增强HIFU的手术消融效果,可作为HIFU的增效剂,但是在使用过程中存在最主要的一个问题是超声造影剂在体内的代谢时间较短,对于较大的肿瘤,治疗效果不满意,人们发现通过静脉持续泵入微泡可以解决这个问题,但其安全使用剂量又令人担忧,那么反过来我们也许能理解为超声造影剂对不同大小的肿瘤的增效作用也不一样。目的:比较研究术前使用微泡超声造影剂(声诺维)与术前未使用超声造影剂,联合hⅠfu治疗不同直径子宫肌瘤的增效作用。材料和方法:1.回顾性分析2015年1月-2015年12月在遂宁市中心医院诊段单发性子宫肌瘤并接受hⅠfu治疗的患者。根据其术前mrⅠ的直径划分为Ⅰ、Ⅱ、Ⅲ组,其中直径3cm为Ⅰ组,3cm≤直径≤5cm为Ⅰ组,直径5cm为Ⅲ组。本研究共150例患者,每组50例患者,每组均选择25例术前及术后造影患者作为造影组;选择25例术前未造影,仅术后造影患者作为未造影组。2.比较治疗过程中造影组及对照组的子宫肌瘤治疗时间、辐照时间、能效因子、消融率、术中副反应发生率等治疗剂量参数。结果:1.在Ⅰ组中,术前造影及术前未造影的治疗时间范围的p值为0.034,有统计学差异。余术前造影及术前未造影术前造影的平均功率为、eef、消融率、消融体积、团块出现时间、团块出现时间、辐照时间、治疗强度、治疗剂量,其p值均大于0.05,均无明显差异。在Ⅱ组中,术前造影及术前未造影的辐照时间、eef、消融体积的p值分别是0.041、0.018、0.029,辐照时间、eef及消融体积存在统计学差异。余术前造影及术前未造影术的治疗时间、平均功率为、消融率、团块出现时间、团块出现率、治疗强度、治疗剂量,其p值均大于0.05,均无明显差异。在Ⅲ组中,术前造影与术前未造影在平均功率、辐照时间、eef、治疗时间、消融率、团块出现时间、团块出现率、治疗强度、治疗剂量,其p值均大于0.05,均无明显差异。2.Ⅰ组、Ⅲ组中术前造影剂组与术前未造影组在放射痛、骶尾部痛、皮肤烫、治疗区痛、腹股沟痛、臀部皱褶痛的p值均大于0.05,均无统计学差异;Ⅱ组中术前造影及未造影在放射痛发生率对比中,p值为0.004,有统计学差异,余下组中术前造影剂组与术前未造影组在骶尾部痛、皮肤烫、治疗区痛、腹股沟痛、臀部皱褶痛的发生率的p值均大于0.05,无统计学差异。结论:1.在超声造影剂对小于3cm的肌瘤及大于5cm的肌瘤的增效作用不明显,可能对3~5cm的子宫肌瘤的有一定的增效作用,所以子宫肌瘤的大小不是影响超声增效的强弱的主要因素。2.本研究Ⅰ、Ⅱ、Ⅲ组不同大小的子宫肌瘤中,术前造影及未造影的副反应发生率无显著性差异,且所有研究患者中均未出现严重并发症,所以术前超声造影结合hⅠfu治疗子宫肌瘤是有安全保障的。
[Abstract]:Background: Uterine leiomyoma belongs to the female reproductive system disease, multiple in the age of childbearing age, the cause of the disease has not been completely studied. The size and growth of uterine leiomyoma affected its clinical symptoms to a large extent, mainly manifested by increased amount, prolonged menstrual period, irregular period, lower abdominal pain, pelvic pressure, and so on. High Intensity Focused Ultrasound (HIFU) has been widely used in the fields of breast, uterus, liver, kidney, pancreas, etc. Treatment of malignant solid tumors[1]. HIFU is a kind of non-invasive physical therapy means, the majority of patients have less post-operative trauma, the post-operative recovery is called invasive surgery, and the integrity of its own organs is preserved, and the above features allow the HIFU technology to gradually become a new choice for the treatment of hysteromyoma by women with large numbers of women. Ultrasound contrast agent (UCA) is a kind of chemical preparation which can significantly enhance the intensity of ultrasonic backscatter. The earliest ultrasonic contrast agent is obtained by hand vibration physiological saline, and only the right heart system imaging can be displayed, and the research proves that the ultrasonic contrast agent can enhance the surgical ablation effect of HIFU, and can be used as a synergist of HIFU, but the most important problem in the use process is that the metabolic time of the ultrasound contrast agent in the body is short, the treatment effect is not satisfactory for larger tumors, it has been found that the problem can be solved by continuously pumping the micro-bubbles through the vein, but the safe use dose is also worrying, In turn, we may be able to understand that ultrasound contrast agents do not have the same synergistic effect on different sizes of tumors. Objective: To compare the synergistic effect of microvesicle ultrasound contrast agent (SonoVue) before and before operation in the treatment of myomectomy with different diameters without using ultrasound contrast agent. Materials and Methods: 1. Retrospective analysis was conducted in January 2015 to December 2015 in patients with solitary uterine fibroids diagnosed in central hospital of Suining City and treated with h I fu. According to the pre-operative mr 鈪，
本文编号：2306560
[Abstract]:Background: Uterine leiomyoma belongs to the female reproductive system disease, multiple in the age of childbearing age, the cause of the disease has not been completely studied. The size and growth of uterine leiomyoma affected its clinical symptoms to a large extent, mainly manifested by increased amount, prolonged menstrual period, irregular period, lower abdominal pain, pelvic pressure, and so on. High Intensity Focused Ultrasound (HIFU) has been widely used in the fields of breast, uterus, liver, kidney, pancreas, etc. Treatment of malignant solid tumors[1]. HIFU is a kind of non-invasive physical therapy means, the majority of patients have less post-operative trauma, the post-operative recovery is called invasive surgery, and the integrity of its own organs is preserved, and the above features allow the HIFU technology to gradually become a new choice for the treatment of hysteromyoma by women with large numbers of women. Ultrasound contrast agent (UCA) is a kind of chemical preparation which can significantly enhance the intensity of ultrasonic backscatter. The earliest ultrasonic contrast agent is obtained by hand vibration physiological saline, and only the right heart system imaging can be displayed, and the research proves that the ultrasonic contrast agent can enhance the surgical ablation effect of HIFU, and can be used as a synergist of HIFU, but the most important problem in the use process is that the metabolic time of the ultrasound contrast agent in the body is short, the treatment effect is not satisfactory for larger tumors, it has been found that the problem can be solved by continuously pumping the micro-bubbles through the vein, but the safe use dose is also worrying, In turn, we may be able to understand that ultrasound contrast agents do not have the same synergistic effect on different sizes of tumors. Objective: To compare the synergistic effect of microvesicle ultrasound contrast agent (SonoVue) before and before operation in the treatment of myomectomy with different diameters without using ultrasound contrast agent. Materials and Methods: 1. Retrospective analysis was conducted in January 2015 to December 2015 in patients with solitary uterine fibroids diagnosed in central hospital of Suining City and treated with h I fu. According to the pre-operative mr 鈪，
本文编号：2306560
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