中华妇产科杂志
中華婦產科雜誌
중화부산과잡지
CHINESE JOUNAL OF OBSTETRICS AND GYNECOLOGY
2010年
12期
909-912
,共4页
陈文直%唐良萏%杨武威%张彦%李静%夏文秀%周洁敏%祝宝让%赵纯全%令狐华%陈锦云%朱丽%邓勇斌%王智彪
陳文直%唐良萏%楊武威%張彥%李靜%夏文秀%週潔敏%祝寶讓%趙純全%令狐華%陳錦雲%硃麗%鄧勇斌%王智彪
진문직%당량담%양무위%장언%리정%하문수%주길민%축보양%조순전%령호화%진금운%주려%산용빈%왕지표
子宫肿瘤%平滑肌瘤%超声疗法%导管消融术%磁共振成像%可重复性,结果
子宮腫瘤%平滑肌瘤%超聲療法%導管消融術%磁共振成像%可重複性,結果
자궁종류%평활기류%초성요법%도관소융술%자공진성상%가중복성,결과
Uterine neoplasms%Leiomyoma%Ultrasonic therapy%Catheter ablation%Magnetic resonance imaging%Reproducibility of results
目的 验证超声消融技术用于子宫肌瘤治疗的安全性、有效性.方法 采用前瞻性、非随机临床研究方法,对重庆医科大学附属第一医院和解放军第三○七医院就诊的99例子宫肌瘤患者(117个肌瘤,肌瘤直径≤10 cm)进行超声消融治疗.仪器为重庆海扶(HIFU)技术有限公司研制的JC型聚焦超声肿瘤治疗系统.治疗在镇静、镇痛下进行,实时超声声像图引导超声消融治疗全过程.治疗后随访期为6个月.治疗后1个月内,行增强磁共振成像(MRI)检查,评价靶肌瘤体积消融率.治疗后3、6个月时,行增强MRI检查,评价靶肌瘤体积缩小率及靶肌瘤体积缩小超过50%的肌瘤占所有肌瘤的百分比.根据子宫肌瘤症状量表(UFS)评价有症状患者的症状评分改善10分者所占比例.依照国际介入放射治疗学会(SIR)标准评价治疗相关的不良反应.结果 (1)有效性:治疗后1个月内,靶肌瘤体积消融率平均为(76±24)%;3、6个月时,靶肌瘤平均体积分别缩小了(45±21)%和(59±26)%,与治疗前比较,差异均有统计学意义(P<0.05).治疗后6个月时,靶肌瘤体积缩小≥50%共99个肌瘤,占84.6%(99/117);UFS症状评分改善10分者占92%(66/72).(2)安全性:全部患者治疗后2 h均可以正常活动.SIR标准中重要不良反应(SIR C～D级:延长住院时间,需要重要治疗,护理等级增加)及严重不良反应(SIR E～F级:永久性后遗症或死亡)的发生率均为0;一般不良反应(SIR A～B级:观察或简单治疗,无不良后果)的发生率为35%(35/99),SIR B级不良反应包括2例声通道皮肤浅Ⅱ度烧伤和2例发热,需要对症治疗及换药处理.其余包括臀部和(或)下肢酸胀痛、阴道分泌异常、排尿困难或疼痛等,均无需治疗,为SIR A级.结论 超声消融技术用于治疗子宫肌瘤是安全、有效的,可以单独用于子宫肌瘤的治疗.
目的 驗證超聲消融技術用于子宮肌瘤治療的安全性、有效性.方法 採用前瞻性、非隨機臨床研究方法,對重慶醫科大學附屬第一醫院和解放軍第三○七醫院就診的99例子宮肌瘤患者(117箇肌瘤,肌瘤直徑≤10 cm)進行超聲消融治療.儀器為重慶海扶(HIFU)技術有限公司研製的JC型聚焦超聲腫瘤治療繫統.治療在鎮靜、鎮痛下進行,實時超聲聲像圖引導超聲消融治療全過程.治療後隨訪期為6箇月.治療後1箇月內,行增彊磁共振成像(MRI)檢查,評價靶肌瘤體積消融率.治療後3、6箇月時,行增彊MRI檢查,評價靶肌瘤體積縮小率及靶肌瘤體積縮小超過50%的肌瘤佔所有肌瘤的百分比.根據子宮肌瘤癥狀量錶(UFS)評價有癥狀患者的癥狀評分改善10分者所佔比例.依照國際介入放射治療學會(SIR)標準評價治療相關的不良反應.結果 (1)有效性:治療後1箇月內,靶肌瘤體積消融率平均為(76±24)%;3、6箇月時,靶肌瘤平均體積分彆縮小瞭(45±21)%和(59±26)%,與治療前比較,差異均有統計學意義(P<0.05).治療後6箇月時,靶肌瘤體積縮小≥50%共99箇肌瘤,佔84.6%(99/117);UFS癥狀評分改善10分者佔92%(66/72).(2)安全性:全部患者治療後2 h均可以正常活動.SIR標準中重要不良反應(SIR C～D級:延長住院時間,需要重要治療,護理等級增加)及嚴重不良反應(SIR E～F級:永久性後遺癥或死亡)的髮生率均為0;一般不良反應(SIR A～B級:觀察或簡單治療,無不良後果)的髮生率為35%(35/99),SIR B級不良反應包括2例聲通道皮膚淺Ⅱ度燒傷和2例髮熱,需要對癥治療及換藥處理.其餘包括臀部和(或)下肢痠脹痛、陰道分泌異常、排尿睏難或疼痛等,均無需治療,為SIR A級.結論 超聲消融技術用于治療子宮肌瘤是安全、有效的,可以單獨用于子宮肌瘤的治療.
목적 험증초성소융기술용우자궁기류치료적안전성、유효성.방법 채용전첨성、비수궤림상연구방법,대중경의과대학부속제일의원화해방군제삼○칠의원취진적99례자궁기류환자(117개기류,기류직경≤10 cm)진행초성소융치료.의기위중경해부(HIFU)기술유한공사연제적JC형취초초성종류치료계통.치료재진정、진통하진행,실시초성성상도인도초성소융치료전과정.치료후수방기위6개월.치료후1개월내,행증강자공진성상(MRI)검사,평개파기류체적소융솔.치료후3、6개월시,행증강MRI검사,평개파기류체적축소솔급파기류체적축소초과50%적기류점소유기류적백분비.근거자궁기류증상량표(UFS)평개유증상환자적증상평분개선10분자소점비례.의조국제개입방사치료학회(SIR)표준평개치료상관적불량반응.결과 (1)유효성:치료후1개월내,파기류체적소융솔평균위(76±24)%;3、6개월시,파기류평균체적분별축소료(45±21)%화(59±26)%,여치료전비교,차이균유통계학의의(P<0.05).치료후6개월시,파기류체적축소≥50%공99개기류,점84.6%(99/117);UFS증상평분개선10분자점92%(66/72).(2)안전성:전부환자치료후2 h균가이정상활동.SIR표준중중요불량반응(SIR C～D급:연장주원시간,수요중요치료,호리등급증가)급엄중불량반응(SIR E～F급:영구성후유증혹사망)적발생솔균위0;일반불량반응(SIR A～B급:관찰혹간단치료,무불량후과)적발생솔위35%(35/99),SIR B급불량반응포괄2례성통도피부천Ⅱ도소상화2례발열,수요대증치료급환약처리.기여포괄둔부화(혹)하지산창통、음도분비이상、배뇨곤난혹동통등,균무수치료,위SIR A급.결론 초성소융기술용우치료자궁기류시안전、유효적,가이단독용우자궁기류적치료.
Objective To investigate the safety and efficacy of ultrasound ablation in treatment of uterine fibroids. Methods Ninety-nine patients with 117 leiomyomas in total treated by Haifu JC focused ultrasound tumor therapeutic system were enrolled in prospective and non-randomized clinical trial in First Affiliated Hospital of Chongqing Medical University and Academy of Military Medical Sciences. Ultrasound ablation was performed guided by real-time ultrasonography under conscious sedation for single session. All patients were followed up at 6 months after treatment. On the day of treatment and after 1 month, patients were given by magnetic resonance imaging(MRI) exam to evaluate the effect of fibroids ablation. At 3 and 6months after treatment, the ratio of ablated area and volume reduction of fibroids more than 50% were evaluated by MRI exam again. The symptoms improvements were evaluated by uterine fibroid symptom (UFS) and complications were analyzed by guideline of society of international radiation (SIR). Results The average ablated area ratio of the target fibroid was (76 ± 24)%. The average reduction in fibroid volume determined by MRI at 3 and 6 months after treatment was (45 ± 21)% and (59 ± 26)%. Which were significantly decreased than those before treatment (P < 0. 05). At 6 months after treatment, 84. 6% (99/117) of patients showed more than 50% volume reduction, the rate of improved symptom score was 92%(66/72). All patients could resume normal daily activities at 2 hours after treatment. The adverse reactions of SIR C - D included delayed hospitalization, repeat treatment and increased level of nursing. E - F included permanent sequelae and death. In this study, no adverse reactions of C - F were recorded. Common complications (SIR A- B, only observation or simple management without sequelae) were 35% (35/99).Four cases with adverse reactions B of SIR were found, including 2 cases with skin burning of degree Ⅱ and 2 cases with febrile, they were administered by symptomatic therapy and changing dressing The other adverse reaction A of SIR included sorness of buttock, vaginal discharge, dysuria and painful urination, they were only suggested by follow-up. Conclusion It was efficacy and safe that ultrasound ablation as a single strategy were used in treatment of uterine fibroids.
