HIFU治疗超声衰减宽度＜10mm声通道腹壁瘢痕子宫肌瘤患者的有效性及安全性

摘要

Objective To evaluate the therapeutic efficacy and safety of HIFU ablation for uterine fibroids in patients with abdominal surgical scars in acoustic pathway causing acoustic attenuation width ＜10 mm.Methods Totally 861 patients with uterine fibroids were referred for HIFU treatment and underwent contrast-enhanced MR scans before and after HIFU ablation.Among all patients,202 had abdominal surgical scars causing width ＜10 mm acoustic attenuation (abdominal scars group) and 659 had no abdominal surgical scars (without abdominal scars group).The outcomes,intra-operative adverse reactions and post-operative complications between the two groups were compared.Results HIFU ablation was successfully performed in all patients.The volume ablation rate was (80.31 ± 18.16)％ in abdominal scars group and (79.60±17.57)％ in without abdominal scars group (P＝0.620).The rate of ‘hot'skin sensation during HIFU procedure in abdominal scars group (52.97％ [107/202]) was higher than that in without abdominal scars group (41.58％ [274/ 659];P＝0.004).Anterior abdominal wall edema was found in 40 cases (40/202,19.80％) in abdominal scars group and 98 cases (98/659,14.87％) in without abdominal scars group on post-operation MRI (P＝ 0.095).Conclusion Prior abdominal surgical scars in acoustic pathway causing width ＜10 mm acoustic attenuation has not significantly influence on the efficacy and safety of HIFU treatment for uterine fibroid.%目的 探讨超声引导下HIFU治疗声通道腹壁瘢痕造成超声衰减宽度＜10 mm的子宫肌瘤患者的安全性及有效性.方法 共纳入861例子宫肌瘤患者,于HIFU消融治疗前后行盆腔增强MR检查,其中202例腹壁瘢痕造成超声衰减宽度＜10 mm(瘢痕组),659例无瘢痕(无瘢痕组),比较2组消融治疗效果、术中不良反应及术后并发症情况.结果 对所有患者均完成HIFU治疗,瘢痕组和无瘢痕组子宫肌瘤体积消融率分别为(80.31±18.16)％、(79.60±17.57)％(P＝0.620).瘢痕组术中皮肤烫发生率[52.97％(107/202)]较无瘢痕组[41.58％(274/659)]高(P＝0.004),瘢痕组和无瘢痕组术后MRI示腹壁水肿发生率分别为19.80％(40/202)、14.87％ (98/659;P＝0.095).结论 超声衰减宽度＜10 mm的声通道腹壁瘢痕对HIFU治疗子宫肌瘤的有效性及安全性无明显影响.