超声消融治疗子宫黏膜下肌瘤的安全性和疗效评价

目的 探讨超声消融治疗突入宫腔体积＜50%的子宫黏膜下肌瘤的安全性及疗效.方法 前瞻性选择2006年10月至2009年9月在解放军总医院妇产科就诊有明显临床症状的、经MRI确诊的突出官腔体积＜50%的子宫黏膜下肌瘤患者66例(68个肌瘤),行超声引导下的聚焦超声消融治疗,记录消融治疗过程中及消融治疗后出现的不良反应;消融治疗后即刻采用超声造影评价消融治疗的疗效,消融治疗后第3、6、12和24个月,超声评价肌瘤体积变化;采用子宫肌瘤相关症状评分表(SSS)和月经期症状评分表评估症状变化.结果 共66例患者的68个黏膜下肌瘤消融治疗前肌瘤平均体积为(151±134)cm3,消融治疗后即刻超声造影中无灌注区平均体积为(114±104)cm3,肌瘤体积消融率为(77±16)%.所有患者均顺利完成治疗,随访时间为6～44个月,中位随访时间24个月,至今未出现显著并发症.消融治疗后有52%(34/66)的患者出现阴道排液症状,均于消融治疗3～4个月经周期后自行恢复正常.消融治疗后第3、6、12和24个月时,SSS评分与消融治疗前比较,分别降低20.9%、38.0%、45.1%、47.1%;月经期症状评分与消融治疗前比较,分别降低42.0%、63.8%、64.2%、68.8%,分别与治疗前比较,差异均有统计学意义(P＜0.05),坏死肌瘤逐渐吸收缩小,肌瘤体积较消融治疗前平均缩小44.7%、66.0%、77.7%和89.8%.结论 超声消融治疗突入宫腔体积＜50%的子宫黏膜下肌瘤安全、有效,黏膜下肌瘤相关症状改善显著.

Abstract：

Objective To evaluate the efficacy and safety of focused ultrasound ablation in the treatment of submucosal fibroids which broke into uterine cavity less than 50%. Methods From Oct. 2006 to Sept. 2009, 66 patients with 69 submucosal fibroids broke into uterine cavity less than 50% diagnosed by MRI in Chinese People's Liberation Army General Hospital were enrolled in this study. They were treated by ultrasound-guided focused ultrasound ablation in the outpatient department, which using the contrast enhanced ultrasonography to assess the efficacy after ablation immediately, to measure reduction of fibroids volume and record adverse effect before and after ultrasound ablation. At 3, 6, 12 and 24 months after treatment, ablation outcome and fibroids volumes were evaluated by contrast ultrasound. The changes of clinical symptom were evaluated by the symptom severity score ( SSS) of the uterine fibroid quality-of-life instrument( UFS-QOL). Results The average volume of fibroids in 66 patients with 68 submucosal fibroids were (151 ±134) cm3 before treatment and (114 ± 104) cm3 no enhanced regional after treatment. The ablation rate of target fibroids was (77 ±16)%. All patients completed this treatment successfully, they were followed up for 6 - 44 months, the median follow-up time was 24 months. No serious complication was observed. However, there were 52% (34/66) patients presented vaginal discharge after ablation, it disappeared gradually after 3 to 4 menstrual cycles. The SSS and the menstrual period symptom scores were significantly lower than that before ablation at the follow-up of 3,6, 12 and 24 months, the rates were 20. 9% , 38. 0% , 45. 1% , 47. 1% and 42. 0% , 63. 8% , 64. 2% , 68. 8% , which all reached statistical difference (P ＜ 0. 05 ). The necrotic fibroids were absorbed gradually, the reduction rates of fibroid volume were 44. 7% ,66. 0% ,77. 7% and 89. 8% . Conclusion It was safe and efficacy that focused ultrasound ablation was used in treatment of submucosal fibroids which broke into the uterine less than 50%.

Efficacy and safety of focused ultrasound ablation in treatment of submucosal uterine fibroids

Objective To evaluate the efficacy and safety of focused ultrasound ablation in the treatment of submucosal fibroids which broke into uterine cavity less than 50%. Methods From Oct. 2006 to Sept. 2009, 66 patients with 69 submucosal fibroids broke into uterine cavity less than 50% diagnosed by MRI in Chinese People's Liberation Army General Hospital were enrolled in this study. They were treated by ultrasound-guided focused ultrasound ablation in the outpatient department, which using the contrast enhanced ultrasonography to assess the efficacy after ablation immediately, to measure reduction of fibroids volume and record adverse effect before and after ultrasound ablation. At 3, 6, 12 and 24 months after treatment, ablation outcome and fibroids volumes were evaluated by contrast ultrasound. The changes of clinical symptom were evaluated by the symptom severity score ( SSS) of the uterine fibroid quality-of-life instrument( UFS-QOL). Results The average volume of fibroids in 66 patients with 68 submucosal fibroids were (151 ±134) cm3 before treatment and (114 ± 104) cm3 no enhanced regional after treatment. The ablation rate of target fibroids was (77 ±16)%. All patients completed this treatment successfully, they were followed up for 6 - 44 months, the median follow-up time was 24 months. No serious complication was observed. However, there were 52% (34/66) patients presented vaginal discharge after ablation, it disappeared gradually after 3 to 4 menstrual cycles. The SSS and the menstrual period symptom scores were significantly lower than that before ablation at the follow-up of 3,6, 12 and 24 months, the rates were 20. 9% , 38. 0% , 45. 1% , 47. 1% and 42. 0% , 63. 8% , 64. 2% , 68. 8% , which all reached statistical difference (P ＜ 0. 05 ). The necrotic fibroids were absorbed gradually, the reduction rates of fibroid volume were 44. 7% ,66. 0% ,77. 7% and 89. 8% . Conclusion It was safe and efficacy that focused ultrasound ablation was used in treatment of submucosal fibroids which broke into the uterine less than 50%.