超声造影评价高强度聚焦超声和射频消融治疗不同大小子宫肌瘤疗效及比较

目的采用超声造影技术评价高强度聚焦超声(HIFU)和射频消融治疗子宫肌瘤的疗效,并比较两者对不同大小子宫肌瘤疗效的差异。方法 100例子宫肌瘤患者共138个肌瘤,随机分为2组,每组各50例,分别接受HIFU及射频消融治疗。HIFU组16例患者24个肌瘤直径2.0～4.0cm,26例患者32个肌瘤直径4.0～6.0cm,8例患者12个肌瘤直径6.0～8.0cm;射频消融组14例患者22个肌瘤直径2.0～4.0cm,27例患者35个肌瘤直径4.0～6.0cm,9例患者13个肌瘤直径6.0～8.0cm。所有患者均于治疗前、后1周内行超声造影。采用Chi-squareχ2检验比较HIFU、射频消融治疗不同大小子宫肌瘤完全消融率、术后并发症发生率。结果 HIFU组、射频消融组直径2.0～4.0cm子宫肌瘤完全消融率分别为91.7%(2/24)和95.5%(1/22),差异无统计学意义(χ2=0.270,P>0.05);HIFU组、射频消融组直径4.0～6.0cm子宫肌瘤完全消融率分别为56.3%(18/32)和94.3%(33/35),HIFU组完全消融率低于射频消融组,且差异有统计学意义(χ2=13.304,P<0.05);HIFU组、射频消融组直径6.0～8.0cm子宫肌瘤完全消融率分别为16.7%(2/12)和76.9%(10/13),HIFU组与射频消融组的完全消融率均降低,但射频消融组的完全消融率仍高于HIFU组,且差异有统计学意义(χ2=10.711,P<0.05)。术后并发症包括发热、下腹部疼痛、盆腔积液、阴道排液及单侧下肢麻木。HIFU组并发症发生率为16.0%(8/50),低于射频消融组的36.0%(18/50),差异有统计学意义(χ2=4.917,P<0.05)。结论 HIFU和射频消融对于直径4.0cm以下子宫肌瘤疗效显著。对于直径6.0cm以上的子宫肌瘤,射频消融可取得较好疗效。HIFU作为一种无创治疗手段,可作为小肌瘤非手术治疗的首选方法。

A comparative study of ablation rates of uterine fibroid with different size using radio frequency and high-intensity focused ultrasound

Objective To compare the complete ablation rates of radiofrequency（RF）ablation and high-intensity focused ultrasound（HIFU）in the treatment of uterine fibroids with different sizes.To provide an experimental basis for the clinical selection of a suitable,minimally invasive method for treating uterine fibroids.Methods One hundred patients with 138 uterine fibroids were randomly divided into two groups and treated with HIFU or RF respectively.Each group had 50 patients.The HIFU group had 16 patients with 24 fibroids which diameters were 2.0-4.0 cm,had 26 patients with 32 fibroids which diameters were 4.0-6.0 cm and had 8 patients with 12 fibroids which diameters were 6.0-8.0 cm.The RF group had 14 patients with 22 fibroids which diameters were 2.0-4.0 cm,had 27 patients with 35 fibroids which diameters were 4.0-6.0 cm and had 9 patients with 13 fibroids which diameters were 6.0-8.0 cm.The complete ablation rates of the two treatments were evaluated by contrast-enhanced ultrasound one week before and after treatments.Statistical analyses were used to compare the complete ablation rates and postoperative complications rates of these two methods.Results When fibroids＇ diameter were 2.0-4.0 cm,the complete ablation rate was 91.7%（2/24）and 95.5%（1/22）in HIFU and RF group,respectively.The difference was not statistically significant（χ2=0.270,P〈0.05）.When fibroids＇ diameter were 4.0-6.0 cm,the complete ablation rate was 56.3%（18/32） and 94.3%（33/35）in HIFU and RF group,respectively.This difference was statistically significant（χ2=13.304,P〈0.05）.When fibroids＇ diameter were 6.0-8.0 cm,the complete ablation rate was 16.7%（2/12）and 76.9%（10/13）in HIFU and RF group,respectively.Although the complete ablation rate decreased in both groups,it was still higher in RF than in HIFU.The difference was statistically significant（χ2=10.711,P〈0.05）.Postoperative complications included fever,abdominal pain,pelvic effusion and vaginal discharge and unilateral lower limb numbness.The incidence of complications was lower in HIFU group than in RF group,which was 16.0%（8/50）and 36.0%（18/50）,respectively.This difference was statistically significant（χ2=4.917,P〈0.05）.Conclusions HIFU and RF are both effective in treating uterine fibroids with diameters less than 4.0 cm.RF can be effective in treating large fibroids.Those fibroids＇diameter are larger than 6.0 cm.As a non-invasive therapy,HIFU is more suitable for small fibroids＇treatment and could be the first-line treating method.