CAJ | 학술논문

目的：探讨实时超声监控下HIFU联合超声微泡增效剂（SonoVue）治疗子宫肌瘤伴盆腔手术史患者的安全性与有效性．方法分析2010年10月至2012年12月宁市中心医院50例子宫肌瘤伴盆腔手术史患者行HIFU联合SonoVue治疗情况，与同期50例无盆腔手术史子宫肌瘤患者进行比较，观察患者治疗中肌瘤非灌注区体积、体积消融率、消融强度、消融剂量、在室时间、治疗时间及治疗后即刻不良反应与远期并发症等．结果手术史组非灌注区体积、体积消融率、消融剂量与非手术史组比较，差异无统计学意义（＞0.05）；手术史组消融强度明显低于非手术史组（＜0.05）；手术史组在室时间、治疗时间明显长于非手术史组（＜0.05）；手术史组治疗中重度及以上疼痛率为46%，明显高于非手术史组20%（＜0.05），2组均无因难以忍受疼痛而终止治疗者．手术史组治疗后下腹部疼痛、皮肤烫伤、骶尾部疼痛明显高于非手术史组（＜0.05），后期随访两组患者均无严重不良反应．结论盆腔手术史增加了HIFU治疗子宫肌瘤操作难度；初步研究提示严格掌握适应症与禁忌症，HIFU联合SonoVue治疗盆腔手术史子宫肌瘤患者也可得到安全有效的治疗．
목적：탐토실시초성감공하HIFU연합초성미포증효제（SonoVue）치료자궁기류반분강수술사환자적안전성여유효성．방법분석2010년10월지2012년12월저시중심의원50례자궁기류반분강수술사환자행HIFU연합SonoVue치료정황，여동기50례무분강수술사자궁기류환자진행비교，관찰환자치료중기류비관주구체적、체적소융솔、소융강도、소융제량、재실시간、치료시간급치료후즉각불량반응여원기병발증등．결과수술사조비관주구체적、체적소융솔、소융제량여비수술사조비교，차이무통계학의의（＞0.05）；수술사조소융강도명현저우비수술사조（＜0.05）；수술사조재실시간、치료시간명현장우비수술사조（＜0.05）；수술사조치료중중도급이상동통솔위46%，명현고우비수술사조20%（＜0.05），2조균무인난이인수동통이종지치료자．수술사조치료후하복부동통、피부탕상、저미부동통명현고우비수술사조（＜0.05），후기수방량조환자균무엄중불량반응．결론분강수술사증가료HIFU치료자궁기류조작난도；초보연구제시엄격장악괄응증여금기증，HIFU연합SonoVue치료분강수술사자궁기류환자야가득도안전유효적치료．
Objective To evaluate the feasibility of high intensity focused ultrasound (HIFU) associated microbubble-enhancing contrast (“SonoVue”) therapeutic ablation of uterine fibroids in patients with pelvic operation history. Methods A total of 100 patients with uterine fibroid from October 2010 to December 2012 in Suining Central Hospital of Sichuan were treated with HIFU associated SonoVue. Among them, 50 patients had pelvic operation history. The no-perfused volume, median fractional ablation, ablation power rate, ablation dose, treatment time and adverse reaction were recorded. Results There was no statistical significance between patients with operation history and without in no-perfused volume and ablation does. The ablation power was lower in patients with operation than without. The treatment time and room time were longer in patients with operation than without. The adverse reactions were higher in patients with operation than without, especially skin pain and lower abdominal pain ( <0.05) . According to short- and long-term follow-up results, no major complications were observed in any patients. Conclusion Pelvic operation history increases the difficulty in treatment of HIFU ablation uterine fibroids. HIFU associated contrast agent SonoVue ablation can be considered a safe and feasible approach to the management of uterine fibroids in patients with pelvic operation history after grasping the indications and contraindications.