CAJ | 학술논문

目的探讨子宫肌瘤的血液供应特征对超声消融治疗剂量的影响.方法 2006年12月至2009年1月,对重庆医科大学附属第一医院妇产科就诊的142例患者的168个肌瘤行超声消融治疗.治疗前采用彩色多普勒超声将靶肌瘤血液供应分为0～4级(因有3例患者的3个肌瘤未完成治疗后1个月内的增强MRI评估,故165个肌瘤纳入分析),血液供应为0级的肌瘤9个、1级34个、2级35个、3级55个、4级32个.治疗后1个月内增强MRI检查测量无灌注区的面积并计算肌瘤体积消融率及其能效因子(EEF,即单位体积肌瘤行超声消融治疗所需能量),比较不同血液供应状态对治疗剂量的影响.根据国际介入放射治疗学会(SIR)的标准,评价治疗相关的副反应发生情况并进行治疗过程中的疼痛评分.结果 (1)体积消融率:0～4级血液供应肌瘤体积消融率分别为79%、89%、92%、86%、71%,0级与2、3级血液供应肌瘤的体积消融率比较,差异有统计学意义(P＜0.05);4级与1、2、3级血液供应肌瘤的体积消融率比较,差异也有统计学意义(P＜0.05).(2)EEF:0～4级血液供应肌瘤消融所需EEF分别为13.19、9.54、12.91、17.83、28.10 J/mm3,4级血液供应肌瘤消融所需EEF明显高于1、2、3级血液供应肌瘤,差异有统计学意义(P＜0.05);肌瘤血液供应与消融所需EEF呈正相关关系(r=0.354,P＜0.01).(3)治疗过程中疼痛评分及副反应发生情况:近85%(120/142)的患者对治疗过程可以较好耐受,治疗过程中疼痛评分均为0～4分.全部病例均无延长住院时间等SIR标准中C～F并发症发生.结论子宫肌瘤超声下的血液供应特征可用于预测超声消融剂量,为临床选择超声消融治疗子宫肌瘤的适宜剂量提供依据.
목적 탐토자궁기류적혈액공응특정대초성소융치료제량적영향.방법 2006년12월지2009년1월,대중경의과대학부속제일의원부산과취진적142례환자적168개기류행초성소융치료.치료전채용채색다보륵초성장파기류혈액공응분위0～4급(인유3례환자적3개기류미완성치료후1개월내적증강MRI평고,고165개기류납입분석),혈액공응위0급적기류9개、1급34개、2급35개、3급55개、4급32개.치료후1개월내증강MRI검사측량무관주구적면적병계산기류체적소융솔급기능효인자(EEF,즉단위체적기류행초성소융치료소수능량),비교불동혈액공응상태대치료제량적영향.근거국제개입방사치료학회(SIR)적표준,평개치료상관적부반응발생정황병진행치료과정중적동통평분.결과 (1)체적소융솔:0～4급혈액공응기류체적소융솔분별위79%、89%、92%、86%、71%,0급여2、3급혈액공응기류적체적소융솔비교,차이유통계학의의(P＜0.05);4급여1、2、3급혈액공응기류적체적소융솔비교,차이야유통계학의의(P＜0.05).(2)EEF:0～4급혈액공응기류소융소수EEF분별위13.19、9.54、12.91、17.83、28.10 J/mm3,4급혈액공응기류소융소수EEF명현고우1、2、3급혈액공응기류,차이유통계학의의(P＜0.05);기류혈액공응여소융소수EEF정정상관관계(r=0.354,P＜0.01).(3)치료과정중동통평분급부반응발생정황:근85%(120/142)적환자대치료과정가이교호내수,치료과정중동통평분균위0～4분.전부병례균무연장주원시간등SIR표준중C～F병발증발생.결론 자궁기류초성하적혈액공응특정가용우예측초성소융제량,위림상선택초성소융치료자궁기류적괄의제량제공의거.
Objective To explore the relationship between therapeutic dosage of ultrasound ablation in treatment of uterine fibroids and imaging characteristics of bloody supply of uterine fibroids by color Doppler ultrasound imaging. Methods One hundred and forty-two patients with 168 fibroids were treated by ultrasound ablation. Before treatment, bloody supply of fibroids were classified into grade 0 -4 by ultrasonography. Three patients lost follow-up with contrast MRI exam within 1 month after treatment, so 165 fibroids were enrolled in this study. Bloody supplies were 9 fibroids in grade 0, 34 fibroids in grade 1, 35 fibroids in grade 2, 55 fibroids in grade 3 and 32 fibroids in grade 4. After 1 month treatment, the treated area without blood supply and ratio of ablation were measured by contrast MRI to evaluate the efficacy of thermal ablation and compare status of blood supple based different therapeutic dosage. According to International Reditherapy for Society ( SIR ) standard, adverse effect and score of pain were evaluated. Results ( 1) Ratio of ablation based; ratios of ablation were 79% in grade 0, 89% in grade 1, 92% in grade 2, 86% in grade 3, 71% in grade 4. It reached statistical difference when blood supply of grade 0 compared with those of grade 2 and 3 (P ＜ 0. 05 ) and blood supply of grade 4 compared with those of grade 1, 2, 3 ( P ＜ 0. 05). (2) Factor of energy efficiency:factor of energy efficiency were 13.19 J/mm3 in degree 0, 9. 54 J/mm3 in degree 1, 12. 91 J/mm3 in degree 2, 17. 83 J/mm3 in degree 3 and 28. 10 J/mm in degree 4. Factor of energy of ablation in degree 4 was significantly higher than those in degree 1, 2 and 3 blood supply (P ＜ 0. 05). It exhibit the positive relationship between blood supply and factor of energy of ablation ( r = 0. 354 ,P ＜ 0. 01). ( 3 ) Score of pain and adverse effect: nearly 85% ( 120/142 ) patients could tolerate this treatment very well. Those scores of pain were in range of 0 to 4. All patients did not extend their hospitalization and C to F of SIR standard was not recorded. Conclusion blood supply of myoma measured by ultrasound could predict dosage of ultrasound ablation, it could help select indicated well patients.