CAJ | 학술논문

　　目的：评价高强度聚焦超声（HIFU）治疗子宫腺肌病的近期疗效及对生活质量的影响。方法：采用HIFU治疗35例子宫腺肌病患者，通过增强磁共振成像（MRI）评价消融的情况，采用彩色多普勒超声监测病灶变化情况；使用标准子宫肌瘤症状及健康相关生活质量（UFS-QOL）量表评价患者临床症状及生活质量改善情况，并随访分析患者不良反应发生及转归。结果：治疗后第2天增强MRI显示子宫腺肌病病灶消融率为（68.9±18.9）%。治疗后所有不良反应均未超过国际介入放射治疗协会（SIR）标准不良反应分级B级。HIFU治疗前病灶体积中位数为36.9 cm3（P25，P75为20.5，44.8 cm3），治疗后1个月病灶体积中位数为19.1 cm3（P25，P75为12.1，31.1 cm3），两者差异有统计学意义（Z=2.801，P=0.005）。HIFU治疗前UFS评分中位数为22.5分（P25，P75为17.5，32.5分），治疗后1个月UFS评分中位数为15.0分（P25，P75为7.5，25.0分），差异有统计学意义（Z=3.695，P=0.000）。治疗前QOL评分为（77.9±10.5）分，治疗后1个月QOL评分为（81.4±13.3）分，差异无统计学意义（t=1.230，P=0.223）。术后痛经症状明显改善（Zc=7.280，P=0.000）。结论：HIFU治疗能有效消融子宫腺肌病病灶，相关临床症状可迅速缓解，病灶明显缩小，但生活质量改善可能需要更长时间。
　　목적：평개고강도취초초성（HIFU）치료자궁선기병적근기료효급대생활질량적영향。방법：채용HIFU치료35례자궁선기병환자，통과증강자공진성상（MRI）평개소융적정황，채용채색다보륵초성감측병조변화정황；사용표준자궁기류증상급건강상관생활질량（UFS-QOL）량표평개환자림상증상급생활질량개선정황，병수방분석환자불량반응발생급전귀。결과：치료후제2천증강MRI현시자궁선기병병조소융솔위（68.9±18.9）%。치료후소유불량반응균미초과국제개입방사치료협회（SIR）표준불량반응분급B급。HIFU치료전병조체적중위수위36.9 cm3（P25，P75위20.5，44.8 cm3），치료후1개월병조체적중위수위19.1 cm3（P25，P75위12.1，31.1 cm3），량자차이유통계학의의（Z=2.801，P=0.005）。HIFU치료전UFS평분중위수위22.5분（P25，P75위17.5，32.5분），치료후1개월UFS평분중위수위15.0분（P25，P75위7.5，25.0분），차이유통계학의의（Z=3.695，P=0.000）。치료전QOL평분위（77.9±10.5）분，치료후1개월QOL평분위（81.4±13.3）분，차이무통계학의의（t=1.230，P=0.223）。술후통경증상명현개선（Zc=7.280，P=0.000）。결론：HIFU치료능유효소융자궁선기병병조，상관림상증상가신속완해，병조명현축소，단생활질량개선가능수요경장시간。
Objective: To evaluate the efficacy of the ultrasound ablation with real-time ultrasonic monitoring in adenomyosis treatment and the effect on life quality. Methods:35 patients with adenomyosis were treated with the high intensity focused ultrasound(HIFU). The effecacy of ablation was evaluate by the enhanced MRI. The lesions were monitored by the color Doppler ultrasound. Clinical symptoms,life quality,the side effects after treatment,as well as prognosis,were recorded by the standard UFS-QOL measuring scale. Results:The ablation ratio of adenomyosis lesion detected by the enhanced dynamic MRI was (68.9±18.9)%on the 2nd day after treatment. All side effects after treatment were under the B-level of the standard classification of International Association of Interventional Radiology (SIR). The size of adenomyosis lesion before treatment [approximately 36.9 (20.5,44.8)cm3] was significantly bigger than that after one month of treatment [19.1 (12.1,31.1)cm3](Z=2.801,P=0.005). The UFS score before treatment [22.5(17.5,32.5)] was higher than that after one month of treatment [15.0 (7.5,25.0)](Z=3.695,P=0.000). However,the QOL before treatment was (77.9±10.5)while the QOL after one month of treatment was (81.4±13.3),respectively (t=1.230,P=0.223). Dysmenorrheal was significantly relieved (Zc=7.280,P=0.000). Conclusions:The ultrasound-guided high intensity focused ultrasound ablation is effective in treatment of adenomyosis,the associated clinical symptoms can be significantly relieved and the size of lesions be significantly reduced. It is a longer follow-up time to improve the quality of life.