B超引导在射频消融子宫肌瘤治疗中的临床应用及疗效评价

目的:研究B超引导在射频消融(RFA)子宫肌瘤治疗中的临床应用及疗效评价。方法:对282例子宫肌瘤在B超引导下进行射频消融治疗,术后3、6、12、24个月分期随访,通过B超检查判断疗效。结果:66例粘膜下子宫肌瘤被成功摘除,另216例壁间肌瘤及不带蒂的浆膜下子宫肌瘤治愈32例(11.3%),显效124例(43.9%,),好转52例(18.4%)无效8例(2.8%),总有效率97.2%。结论:在B超引导下射频消融子宫肌瘤是目前微创手术治疗子宫肌瘤的一种好方法,而B超是评介RFA疗效的有效方法。     

射频消融技术对子宫肌瘤组织中ER、PR表达影响的临床试验研究

目的 :开腹直视下射频消融子宫肌瘤后 ,观察射频消融对子宫肌瘤组织中ER、PR表达的影响 ,初探射频治疗子宫肌瘤的机制。方法 :30例需开腹行子宫切除术的多发性子宫肌瘤患者 ,分别用 0 .5cm、1.2cm长的射频自凝刀行肌瘤部位射频消融 ,治疗后立即切除子宫 ,作为试验组 ,并于消融灶中心 (A组 )、边缘 (B组 )、边缘外 1cm(C组 )、边缘外 2cm(D组 )处取材 ,HE染色观察病理变化 ,免疫组化检测ER、PR水平 ;选同一子宫上未做射频治疗的肌瘤组织作为对照组。结果 :射频治疗后 ,消融灶中心肌瘤组织呈凝固性坏死 ,ER、PR无表达 ;消融灶边缘肌瘤细胞变性 ,ER、PR表达减少 (P <0 .0 5 ) ;消融灶边缘外1cm ,肌瘤细胞无变性、坏死 ,但ER、PR表达低于对照组 (P <0 .0 5 ) ;消融灶边缘外 2cm ,ER、PR与对照组差异无显著性 (P >0 .0 5 )。结论 :射频消融技术使肌瘤组织凝固性坏死 ,ER、PR的表达丧失及低表达是射频消融技术能够治疗子宫肌瘤的循证依据     

温度控制和功率控制射频消融治疗子宫肌瘤临床研究

目的 评估温度控制模式和功率控制模式射频消融术治疗子宫肌瘤的安全性和有效性。方法 选择子宫肌瘤192例，随机分为温控模式射频消融组（温控组）和功控模式射频消融组（功控组），两组患者平均年龄、肌瘤平均体积无明显差异。治疗过程采用超声监控，观察两组治疗时间，穿刺消融次数．术中出血量及术后肌瘤体积改变，评价射频消融术治疗子宫肌瘤的可行性及对两种射频消融模式进行比较。结果温控组平均治疗时间为（25．1±5．8）min，功控组平均治疗时间为（22．4±3．5）min，两者差异无显著性（P〉0．05）。温控组术中平均出血量（10±1．3）ml，功控组术中平均出血量（35±5．9）ml，两者差异有显著性（P（0．05）。温控组每个肌瘤平均实施穿刺消融（2．0±1．1）次，功控组每个肌瘤平均实施穿刺消融（4．4土2．6）次，两组差异有显著性（P〈0．05）。随访6个月，温控组有效率为95．7％，功控组有效率为97．6％，两组差异无显著性（P〉0．05）。结论 射频消融术治疗子宫肌瘤是一种疗效肯定，安全可行的微创治疗方法。温控模式下实施射频消融子宫肌瘤，穿刺次数少，出血少，对子宫损伤小。操作风险低。     

超声引导下射频消融治疗子宫肌瘤的研究进展

子宫肌瘤又称平滑肌瘤或肌瘤,是女性生殖器官最常见的良性肿瘤,由平滑肌和结缔组织组成,常见于30～50岁妇女,发病率约20%。子宫肌瘤的治疗包括保守治疗及手术治疗,其中射频消融（RFA）是一种微创治疗手段,目前已应用于多种疾病,在治疗妇科良性疾病方面的价值也得到了充分的认可。理想的RFA是运用热能以微创的方式、不损伤邻近正常组织的前提下,使靶组织遭受到彻底的破坏。现从作用机制、超声造影技术的临床应用、疗效评价、对生育功能的影响、安全性和有效性、影响因素等方面对RFA治疗子宫肌瘤进行简要概述。     

超声引导下射频消融治疗子宫肌瘤的研究进展

子宫肌瘤又称平滑肌瘤或肌瘤,是女性生殖器官最常见的良性肿瘤,由平滑肌和结缔组织组成,常见于30~50岁妇女,发病率约20%。子宫肌瘤的治疗包括保守治疗及手术治疗,其中射频消融(RFA)是一种微创治疗手段,目前已应用于多种疾病,在治疗妇科良性疾病方面的价值也得到了充分的认可。理想的RFA是运用热能以微创的方式、不损伤邻近正常组织的前提下,使靶组织遭受到彻底的破坏。现从作用机制、超声造影技术的临床应用、疗效评价、对生育功能的影响、安全性和有效性、影响因素等方面对RFA治疗子宫肌瘤进行简要概述。     

腹腔镜下冷极射频治疗子宫肌瘤27例临床观察

子宫肌瘤是妇科多发病、常见病,其中育龄妇女子宫肌瘤的发病率为20%~30%[1]。目前,临床多使用药物、介入及手术治疗。射频消融作为一种微创手术治疗方法,已经逐渐在临床上得到应用,我院2005年9月至2006年6月利用冷极射频肿瘤治疗机,在腹腔镜下治疗肌壁间或浆膜下子宫肌瘤,取得满意疗效,现报道如下。1资料与方法1.1一般资料本组病例27例,年龄29~40岁,平均35岁;均经超声证实为肌壁间向浆膜突起或浆膜下子宫肌瘤,其中单发肌瘤直径≤6cm;多发肌瘤数≤3个、直径<3cm(子宫体为3个月妊娠大小);无腹部手术史;月经干净后3~7d;放置宫内节育器者取出宫…     

射频消融治疗子宫肌瘤疗效评价

国内外应用射频消融治疗子宫肌瘤已有10年以上的历史,特别是近年来的探索,使该技术日臻规范化并得到医学界的认可。文章主要阐述施术指征、技术操作规程、术中术后并发症的防治、疗效判断、随访要点、术后对遗漏肌瘤和再发肌瘤的处理等问题。     

射频消融与微波消融治疗子宫肌瘤的疗效比较

目的分析射频消融与微波消融治疗子宫肌瘤的疗效。方法选取2014年2月~2015年2月收治的子宫肌瘤患者100例,对其病历资料进行回顾性分析,将其随机分为对照组和观察组,对照组应用微波消融治疗,观察组应用射频消融治疗,对比两组患者的术中生命体征情况和并发症发生情况。结果观察组不良反应发生情况低于对照组,同时各项生命体征变化情况优于对照组,差异有统计学意义(P0.05)。观察组治疗前后子宫肌瘤体积变化与对照组比较,差异无统计学意义(P0.05)。结论子宫肌瘤患者应用射频消融和微波消融治疗,疗效均显著,射频消融治疗不良反应发生率较低,值得临床推广和应用。     

B超引导下自凝刀射频治疗子宫肌瘤204例分析

目的 探讨自凝刀射频治疗子宫肌瘤的临床价值。方法 2001年11月至2003年3月选择自愿接受自凝刀射频治疗子宫肌瘤的患者204例，肌瘤227个，瘤体直径1．5～5．5cm，在B超监视和引导下将自凝刀经阴道宫颈置入肌瘤进行射频治疗。结果 治疗后随访3个月204例，6个月178例(221个肌瘤)，治疗有效率分别为87．22％(198／227)和96．38％(213／221)。直径≤3cm的肌瘤、黏膜下肌瘤、宫颈肌瘤有效率达100％。结论 自凝刀射频治疗子宫肌瘤是一种能保留子宫的微创技术，可重复治疗，疗效确切，操作简单，易推广应用。     

微创手术治疗子宫肌瘤的现状

子宫肌瘤是女性生殖系统最常见的良性肿瘤。传统的治疗方法主要有期待治疗、药物治疗和开腹手术治疗,近年微创手术治疗子宫肌瘤因有效、安全、不良反应小而备受医生和患者青睐。目前在临床上使用的微创方法主要分为两大类:肌瘤切除术及缩瘤术或者消融术。前者主要有腹腔镜下子宫肌瘤剔除术、宫腔镜下子宫肌瘤剔除术和经阴道子宫肌瘤剔除术;后者主要有子宫动脉栓塞术、子宫肌瘤热消融术、超声聚焦及超声引导下肌瘤内注入细胞灭活剂等。简要介绍微创手术治疗子宫肌瘤的现状与进展。     

Treatment of uterine fibroids: current findings with gonadotropin-releasing hormone agonists.

The gonadotropin-releasing hormone agonists have potential benefit as presurgical adjuncts in the management of uterine leiomyomas or fibroids. Uterine fibroids contain estrogen receptors and are responsive to therapeutic hormonal manipulation; gonadotropin-releasing hormone agonists are effective by inducing a state of hypoestrogenism. Clinical trials with gonadotropin-releasing hormone agonists consistently have demonstrated efficacy for decreasing both myoma size and uterine volume. The advantages of the preoperative use of gonadotropin-releasing hormone agonists include a reduction in uterine and myoma size and vascularity and potentially improved operative technique and uterine cavity integrity. Ongoing clinical trials will be needed to confirm the role of gonadotropin-releasing hormone agonists in the treatment of uterine fibroids.     

Embolization of uterine fibroids and infertility: is a clinical trial conceivable?

Uterine artery embolization is a recent technique intended for treating uterine fibroids, as an alternative to hysterectomy. The possible side effects putting at stake the prognosis of fertility after embolization are considered as a brake to its use for the treatment of infertility associated with myoma. Secondary hysterectomy and permanent amenorrhea are the two main risks. But they are not so frequent and can be prevented. To date, the experience in the field of fertility and pregnancy after arterial embolization for fibroids is quite limited. However, first results are encouraging and not very different from those observed after surgical myomectomy. A therapeutic trial using arterial embolization for the management of fibroids within a context of infertility can be devised in the presence of submucosal or intramural myomas responsible for metromenorrhagia and with no major infertility factors associated. It is likely that uterine artery embolization should provide results equivalent or superior to those of surgical myomectomy in case of numerous and intramural fibroids with no prevailing myoma. Arterial embolization could be also interesting in case of recurrent myoma after laparotomic myomectomy.     

Cryomyolysis,a new procedure for the conservative treatment of uterine fibroids

Conservative surgical options for uterine myomata traditionally were abdominal myomectomy, laparoscopic myomectomy, and, more recently, myolysis. Each of these procedures has distinct advantages, but also apparent disadvantages. We attempted to introduce an additional option for conservative surgical treatment of fibroids by freezing the structures, a procedure termed cryomyolysis. In this pilot study, 14 women were pretreated with a gonadotropin-releasing hormone (GnRH) agonist for a minimum of 2 months preoperatively to minimize uterine and myoma size. Cryomyolysis was performed and the GnRH agonist was discontinued. Magnetic resonance imaging scans were performed in 10 of the 14 women after GnRH agonist treatment but before surgery, and 4 months postoperatively. Total uterine volume ranged from 41.3 to 1134.8 ml preoperatively, and 49.5 to 1320 ml postoperatively (mean increase 22% after discontinuation of GnRH agonist). Normal uterine volume ranged from 35.6 to 548.7 ml preoperatively and 45.1 to 729.6 ml postoperatively (mean increase 40%); however, myoma volume showed a mean decrease of 6% (range-87-28%). Analysis of only frozen myomata revealed a mean volume decrease of 10%. Cryomyolysis maintains at or slightly reduces these lesions to post-GnRH agonist size, and all other uterine tissue returns to pretreatment size. We believe cryomyolysis may be an effective conservative surgical approach to uterine fibroids.     

Radiofrequency Ablation of Uterine Fibroids: a Review

Laparoscopic, ultrasound-guided radiofrequency ablation (RFA) is a new, FDA-cleared uterine sparing, outpatient procedure for uterine fibroids. The procedure utilizes recent technological advancements in instrumentation and imaging, allowing surgeons to treat numerous fibroids of varying size and location in a minimally invasive fashion. Early and mid-term data from multi-center clinical trials have demonstrated safety and efficacy, with resolution or improvement of symptoms and significant volume reduction. Re-intervention rates for fibroid symptoms have been low. The procedure is well tolerated with a typically uneventful and rapid recovery requiring NSAIDs only for postoperative pain. While post RFA pregnancy data are limited, the results are promising.     

Factors affecting early surgical intervention after uterine artery embolization

Uterine artery embolization (UAE) is an effective technique for the management of uterine myoma. However, complications of this procedure can be serious, including uterine infection and bowel necrosis in conjunction with necrosis of subserous or pedunculated myomas. Treatment failure is more likely to occur in the presence of submucosal myoma associated with a uterine infection or a large myoma of more than 8 cm. Accordingly, patients whose primary symptoms include submucosal myoma and menorrhagia are best treated with a hysteroscopic myomectomy or hysterectomy. The role of the gynecologist is crucial for most effective management and safe use of uterine artery embolization. TARGET AUDIENCE: Obstetricians & Gynecologists, Family Physicians LEARNING OBJECTIVES: After completion of this article, the reader will be able to list the complications of uterine artery embolization for fibroids, to describe postembolization syndrome, and identify the myomas that are more likely to fail uterine artery embolization.     

Update of Conservative Systemic Treatment of Uterine Fibroids

Uterine fibroids are a common disease in women and lead to different symptoms, like pain and bleeding disorders. Aside from surgical treatment, there are many medical treatment options, which are presented in this article. Combined oral contraceptives and Levonorgestrel-releasing intrauterine systems are possible options for bleeding disorders that are a consequence of uterine fibroids. Gonadotropin-releasing hormone agonists and the new selective progesterone receptor modulator Ulipristal acetate can effectively reduce myoma mass and vaginal bleeding rate. Ulipristal acetate should especially be considered in symptomatic women, as it has only a few noteworthy side effects.     

Laparoscopic myomectomy using the argon beam coagulator

Fourteen patients with symptomatic uterine fibroids underwent laparoscopic myomectomy using the argon beam coagulator (ABC). The ABC provides conventional unipolar coagulating current in a nontouch technique, which aids in dissection of the myoma in a hemostatic fashion. Minimal smoke production yields excellent visualization. Fibroids ranged from 2 cm to 6 cm, and eight of the patients had multiple fibroids removed. There were no intraoperative complications and there was minimal operative blood loss. The ABC is a safe and effective tool for laparoscopic removal of symptomatic uterine fibroids.