CAJ | 학술논문

目的通过超声造影技术评价高强度聚焦超声（HIFU）和射频（RF）消融治疗不同等级血供子宫肌瘤的疗效并进行比较。方法2009年1-12月第四军医大学西京医院110例子宫肌瘤患者共146个肌瘤随机分为HIFU组及RF组，每组各55例，分别接受HIFU及RF治疗。术前对肌瘤行彩色多普勒血流成像检查，将肌瘤内血供半定量分为G1、G2、G3三级。HIFU组患者肌瘤血供G1级15例患者共20个肌瘤，G2级32例患者共38个肌瘤，G3级8例患者共10个肌瘤。RF组患者G1级14例患者共18个肌瘤，G2级31例患者共42个肌瘤，G3级10例患者共18个肌瘤。所有患者均于治疗前、后1周内行超声造影。肌瘤内部无造影剂灌注，周边光滑完整为消融完全；肌瘤内部及（或）边缘出现不规则片状增强区者为消融不全。采用Chi-squareχ2检验比较HIFU组与RF组不同等级血供子宫肌瘤完全消融率、HIFU组与RF组患者术后并发症发生率。结果血供为G1级的子宫肌瘤， HIFU组与RF组完全消融率差异无统计学意义[80.0%（16/20）vs 88.9%（16/18），χ2=0.563， P＞0.05]；血供为G2级、G3级的子宫肌瘤，RF组完全消融率均高于HIFU组[90.5%（38/42） vs 55.3%（21/38），72.2%（13/18） vs 20.0%（2/10）]，且差异均有统计学意义（χ2值分别为12.778、7.049，P均＜0.05）。术后并发症包括发热、下腹部疼痛、盆腔积液、阴道排液及单侧下肢麻木。HIFU组术后并发症发生率低于RF组[9.1%（5/55）vs 27.3%（15/55）]，且差异有统计学意义（χ2=6.111，P＜0.05）。结论 HIFU和RF对于血供稀少的肌瘤均有较好的消融效果；而对于血供较丰富的子宫肌瘤，RF的治疗效果优于HIFU。因此，RF适用于大部分的子宫肌瘤。而HIFU作为一种无创治疗手段，并发症少，可做为少血供子宫肌瘤非手术治疗的首选方法。
목적통과초성조영기술평개고강도취초초성（HIFU）화사빈（RF）소융치료불동등급혈공자궁기류적료효병진행비교。방법2009년1-12월제사군의대학서경의원110례자궁기류환자공146개기류수궤분위HIFU조급RF조，매조각55례，분별접수HIFU급RF치료。술전대기류행채색다보륵혈류성상검사，장기류내혈공반정량분위G1、G2、G3삼급。HIFU조환자기류혈공G1급15례환자공20개기류，G2급32례환자공38개기류，G3급8례환자공10개기류。RF조환자G1급14례환자공18개기류，G2급31례환자공42개기류，G3급10례환자공18개기류。소유환자균우치료전、후1주내행초성조영。기류내부무조영제관주，주변광활완정위소융완전；기류내부급（혹）변연출현불규칙편상증강구자위소융불전。채용Chi-squareχ2검험비교HIFU조여RF조불동등급혈공자궁기류완전소융솔、HIFU조여RF조환자술후병발증발생솔。결과혈공위G1급적자궁기류， HIFU조여RF조완전소융솔차이무통계학의의[80.0%（16/20）vs 88.9%（16/18），χ2=0.563， P＞0.05]；혈공위G2급、G3급적자궁기류，RF조완전소융솔균고우HIFU조[90.5%（38/42） vs 55.3%（21/38），72.2%（13/18） vs 20.0%（2/10）]，차차이균유통계학의의（χ2치분별위12.778、7.049，P균＜0.05）。술후병발증포괄발열、하복부동통、분강적액、음도배액급단측하지마목。HIFU조술후병발증발생솔저우RF조[9.1%（5/55）vs 27.3%（15/55）]，차차이유통계학의의（χ2=6.111，P＜0.05）。결론 HIFU화RF대우혈공희소적기류균유교호적소융효과；이대우혈공교봉부적자궁기류，RF적치료효과우우HIFU。인차，RF괄용우대부분적자궁기류。이HIFU작위일충무창치료수단，병발증소，가주위소혈공자궁기류비수술치료적수선방법。
Objective To compare the complete ablation rate of radiofrequency (RF) ablation and high-intensity focused ultrasound (HIFU) in the treatment of uterine ifbroids with different blood supply. Methods One hundred and ten patients with 146 uterine ifbroids in Xijing Hospital of the Fourth Military Medical University from January 2009 to December were randomly divided into two groups and treated with HIFU or RF respectively. Each group had 55 patients. All patients were examined by color Doppler lfow imaging before the treatment. The blood supply of ifbroids were semi-quantitatively classiifed into three grades including G1, G2 and G3. The HIFU group had 15 patients with 20 ifbroids in which blood supply was G1, had 32 patients with 38 ifbroids in which blood supply was G2, and had 8 patients with 10 ifbroids in which blood supply was G3. The RF group had 14 patients with 18 ifbroids in which blood supply was G1, had 31 patients with 42 ifbroids in which blood supply was G2, and had 10 patients with 18 ifbroids in which blood supply was G3. The complete ablation rates of the two treatments were evaluated by contrast-enhanced ultrasound one week before and after treatments. Fibroids which had no contrast agent perfusion and smooth boundary were completely ablated. Statistical analyses were used to compare the complete ablation rates and postoperative complications rates of these two methods. Results When ifbroid′s blood supply was G1, the complete ablation rate was 80.0%(16/20) and 88.9%(16/18) in HIFU and RF group, respectively. The difference was not statistically signiifcant (χ2=0.563, P>0.05). When ifbroid′s blood supply was G2 and G3, the complete ablation rate in HIFU and RF group was 90.5%(38/42) vs 55.3%(21/38) and 72.2% (13/18) vs 20.0% (2/10), respectively. There was statistically difference between these two groups (χ2 =12.778, P < 0.05;χ2=7.049, P < 0.05, respectively). Postoperative complications included fever, abdominal pain, pelvic effusion and vaginal discharge and unilateral lower limb numbness. The incidence of complications was lower in HIFU group than that in RF group, which was 9.1%(5/55) and 27.3%(15/55) respectively, This difference was statistically signiifcant (χ2=6.111, P<0.05). Conclusions HIFU and RF are both effective in treating uterine ifbroids with few blood supply. However, RF can be more effective than HIFU in treating hypervascular ifbroids. Therefore, RF might be able to apply to majority of the ifbroids. As a non-invasive therapy, HIFU is more suitable for hypovascular ifbroids and could be the ifrst therapy in clinic.