CAJ | 학술논문

目的探讨超声引导经皮穿刺微波消融治疗弥漫性子宫腺肌病的可行性.方法收集解放军总医院和解放军总医院第一附属医院妇产科2010年1月至2011年1月就诊,经MRI诊断的子宫腺肌病患者22例(平均年龄39.2岁),伴有严重痛经或贫血症状.超声引导下经皮穿刺于病灶内植入微波天线进行消融,消融范围大于病灶范围1/2以上时完成治疗.治疗中及治疗后观察有无严重并发症、不良反应及近期临床疗效.结果子宫体最大纵切面消融面积71％ (50％～80％),平均消融时间700 s.消融中及消融后伞部患者无严重并发症发生.21例治疗当月月经来潮,1例治疗后30 d月经来潮,伞部患者治疗后月经量较治疗前明显减少.17例治疗后当月痛经症状完伞消失,4例明显减轻,1例无明显改善.治疗后痛经评分由治疗前平均7分降至3分(采用1～10分评分系统).全部患者治疗后未发现穿刺针道有子宫内膜异位种植现象.结论超声引导经皮穿刺治疗弥漫性子宫腺肌病病灶灭活效果确切,治疗后临床症状可得到有效缓解,治疗创伤小,安全,有望成为保留子宫基础上治疗症状性子宫腺肌病的有效方法.
목적 탐토초성인도경피천자미파소융치료미만성자궁선기병적가행성.방법 수집해방군총의원화해방군총의원제일부속의원부산과2010년1월지2011년1월취진,경MRI진단적자궁선기병환자22례(평균년령39.2세),반유엄중통경혹빈혈증상.초성인도하경피천자우병조내식입미파천선진행소융,소융범위대우병조범위1/2이상시완성치료.치료중급치료후관찰유무엄중병발증、불량반응급근기림상료효.결과 자궁체최대종절면소융면적71％ (50％～80％),평균소융시간700 s.소융중급소융후산부환자무엄중병발증발생.21례치료당월월경래조,1례치료후30 d월경래조,산부환자치료후월경량교치료전명현감소.17례치료후당월통경증상완산소실,4례명현감경,1례무명현개선.치료후통경평분유치료전평균7분강지3분(채용1～10분평분계통).전부환자치료후미발현천자침도유자궁내막이위충식현상.결론 초성인도경피천자치료미만성자궁선기병병조멸활효과학절,치료후림상증상가득도유효완해,치료창상소,안전,유망성위보류자궁기출상치료증상성자궁선기병적유효방법.
Objective To assess the feasibility of percutaneous microwave ablation in the treatment of diffuse adenomyosis.Methods With a mean age of 39.2 years old,16 patients with symptomatic adenomyosis underwent percutaneous microwave ablation (PMA).The symptoms included severe dysmenorrheal and anemia.The definite diagnosis was made by magnetic resonance ( MR ) imaging.Two microwave therapeutic antennas were inserted into the myometrium with adenomyosis.The microwave emission was seized when the ablated zone was over half of the total lesion.The complications,side effects and early therapeutic effects were observed during the period of treatment and at 3 and 6 months post treatment.Results The average ablation duration was 700 s.The average ablated area was 72 ％ ( range:60％ - 80％ ).None of the patients developed complications during and after ablation.Fifteen patients had normal menstrual onset during the month of receiving ablation and one case at Day 30.The amount of menstrual bleeding was less than that before treatment.Dysmenorrhea disappeared after treatment in 13 cases,relieved markedly in 2 and no improvement in 1.The endometrial ectopic growth was not observed after treatment.Conclusion The early clinical efficacy of PMA under ultrasound guidance is definite in the treatment of adenomyosis.The symptoms may be eliminated or effectively relieved after treatment.Easy to perform,minimal invasive and safe,the procedure of PMA is an effective therapeutic modality for adenomyosis with the preservation of uterus.