CAJ | 학술논문

目的：比较肌壁间、粘膜下和浆膜下子宫肌瘤超声消融治疗的效果及差异。方法前瞻性研究应用超声消融治疗症状性子宫肌瘤的疗效，用MRI评估肌瘤体积消融率及治疗后6、12个月的体积变化，使用症状严重程度评分表（SSS）评估患者临床症状变化情况。结果2011年8月~2012年12月单中心110例患者145个肌瘤纳入本研究，其中肌壁间肌瘤72（49.7%），粘膜下肌瘤49（33.8%），浆膜下肌瘤24（16.6%）。治疗后体积消融率分别为（93.2±13.1）%、（94.9±9.3）%和（89.6±19.3）%，不同类型肌瘤体积消融率无统计学差异（P>0.05）。治疗后6个月、12个月体积分别缩小（47.3±20.8）%、（70.3±22.2）%、（47.8±13.6）%和（58.9±19.9）%、（82.0±21.2）%、（50.5±17.8）%，粘膜下肌瘤体积缩小率大于肌壁间与浆膜下肌瘤（P<0.05）。临床症状分别以肌壁间、粘膜下和浆膜下肌瘤为主的患者治疗前SSS评分分别为（29.1±15.2）、（34.8±14.5）、（26.6±23.4），治疗后6个月和12个月SSS评分分别为（18.4±15.8）、（15.5±10.7）、（11.6±11.7）和（18.9±13.2）、（16.8±14.0）、（11.5±9.1），与治疗前相比差异均有统计学意义（P<0.05）。所有患者均无严重并发症发生。结论超声消融治疗肌壁间、粘膜下和浆膜下肌瘤均获得了较高的体积消融率，术后6、12个月随访肌瘤体积缩小和临床症状改善显著，可以为有保留子宫意愿的肌瘤患者提供一种新的治疗选择。
목적：비교기벽간、점막하화장막하자궁기류초성소융치료적효과급차이。방법전첨성연구응용초성소융치료증상성자궁기류적료효，용MRI평고기류체적소융솔급치료후6、12개월적체적변화，사용증상엄중정도평분표（SSS）평고환자림상증상변화정황。결과2011년8월~2012년12월단중심110례환자145개기류납입본연구，기중기벽간기류72（49.7%），점막하기류49（33.8%），장막하기류24（16.6%）。치료후체적소융솔분별위（93.2±13.1）%、（94.9±9.3）%화（89.6±19.3）%，불동류형기류체적소융솔무통계학차이（P>0.05）。치료후6개월、12개월체적분별축소（47.3±20.8）%、（70.3±22.2）%、（47.8±13.6）%화（58.9±19.9）%、（82.0±21.2）%、（50.5±17.8）%，점막하기류체적축소솔대우기벽간여장막하기류（P<0.05）。림상증상분별이기벽간、점막하화장막하기류위주적환자치료전SSS평분분별위（29.1±15.2）、（34.8±14.5）、（26.6±23.4），치료후6개월화12개월SSS평분분별위（18.4±15.8）、（15.5±10.7）、（11.6±11.7）화（18.9±13.2）、（16.8±14.0）、（11.5±9.1），여치료전상비차이균유통계학의의（P<0.05）。소유환자균무엄중병발증발생。결론초성소융치료기벽간、점막하화장막하기류균획득료교고적체적소융솔，술후6、12개월수방기류체적축소화림상증상개선현저，가이위유보류자궁의원적기류환자제공일충신적치료선택。
Objective To evaluate the effect of ultrasound-guided focused ultrasound ablation (US-FUA) in the treatment of intramural, submucosal and subserosal uterine fibroids. Methods We prospectively assessed the efficacy of US-FUA for treatment of symptomatic uterine fibroids by determining the volume ablation ratio immediately after the treatment and evaluating the volume changes of the uterine fibroids on contrast-enhanced MRI at 6 and 12 months after the treatment. The symptom severity score (SSS) was examined before and at 6 and 12 months after the treatment. Results A total of 110 women with 145 symptomatic fibroids undergoing US-FUA between August 2011 and December 2012 were enrolled. The fibroids were located intramurally in 72 (49.7%), submucosally in 49 (33.8%) and subserosally in 24 (16.6%) patients, who had comparable mean volume ablation ratios [(93.2 ± 13.1)% vs (94.9 ± 9.3)% vs (89.6 ± 19.3)%, P>0.05]. The volume of the treated fibroids was reduced by (47.3 ± 20.8)%, (70.3 ± 22.2)%and (47.8 ± 13.6)%at 6 months after US-FUA and by (58.9 ± 19.9)%, (82.0 ± 21.2)%, and (50.5±17.8)%at 12 months, respectively, demonstrating a more obvious volume reduction for submucosal fibroids (P<0.05). The SSS scores of the 3 groups before treatment were 29.1±15.2, 34.8±14.5 and 26.6±23.4, respectively, which decreased significantly to 18.4 ± 15.8, 15.5 ± 10.7, and 11.6 ± 11.7 at 6 months (P<0.05) and to 18.9 ± 13.2, 16.8 ± 14.0, 11.5 ± 9.1 at 12 months (P<0.05). No major complications occurred in these patients during the 12-month follow-up. Conclusions US-FUA can yield high ablation ratios for intramural, submucosal and subserosal fibroids and result in significant volume reduction and symptomatic improvement at 6 and 12 months after the treatment, suggesting its value as a new noninvasive option for fibroid treatment in patients who wish to preserve the uterus.