超声造影在经皮微波消融治疗子宫肌层良性病变围手术期中的作用

摘要

Objective To assess the value of contrast-enhanced ultrasound ( CEUS ) in evaluating the therapeutic efficacy of percutaneous microwave ablation on benign uterine muscle lesions. Methods Ultrasound-guided( US ) percutaneous microwave ablation was performed on 22 patients with 24 uterine muscularis benign lesions ( 16 intramural, submucosal and subserosal myomas, 8 uterine adenomyosis ). CEUS was performed on 22 patients before,immediately after and 12-24 hours after treatment, and the enhanced pattern of all lesions was observed. The non-enhanced volumes was compared immediately and 12-24 hours after ablation. Results Before ablation,of all the 22 cases, 14 cases of 16 uterine myomas exhibited peripheral enhancement pattern; 8 adenomyosis lesions exhibited fast enhancement,the boundary of lesion and the surrounding muscle was not clear subsequently. Immediately after microwave ablation, the non-enhanced ablation areas of 19 lesions were spherical or irregular shaped with rough edges. Linear and flake enhancements were detected in the ablation area owing to the persistence of thermal field. Twelve to 24 hours after ablation,the ablated boundary of 17 lesions were relatively sharp,and the non-enhanced area was uniform. The ablation volume immediately after treatment 83. 41 ±72. 83 )cm was smaller than the volume 12-24 hours after treatment( 94.73 ± 80.37 )cm3 ,but they were not significantly different ( t = 1. 138 ,P = 0.267 ). Conclusions In percutaneous microwave ablation of uterine muscle benign lesions, the CEUS images exhibited distinct characteristics. CEUS within 12-24 hours after microwave ablation can accurately determine the scope of postoperative necrosis.%目的 探讨超声造影在经皮微波消融治疗子宫肌层良性病变围手术期中的应用价值.方法 采用微波消融治疗仪对22例患者24个子宫肌层良性病灶(子宫肌壁间、黏膜下和浆膜下肌瘤16个、弥漫性和局限性腺肌病病灶8个)进行微波消融治疗.微波治疗前、治疗后即刻和治疗后12~24 h均行超声造影,观察消融灶增强表现,并对无造影剂灌注区体积进行测量.结果 22例患者微波治疗前后超声造影图像特征:微波治疗前,14例子宫肌瘤16个病灶呈周边强化方式,8例腺肌病8个病灶快速优先增强,峰值时病灶与周围肌层分界不清晰.微波消融后即刻,超声造影显示24个消融灶呈边缘毛糙的类球形或不规则形无增强区,内可见线状、片状热场未消散所致的高增强.微波消融后12~24 h内再次造影,19个消融灶显示为边界较锐利、均匀一致的无增强.微波消融后即刻超声造影显示无造影剂灌注区体积为(83.41±72.83)cm3,小于微波消融后12~24 h的(94.73±80.37)cm3,但差异无统计学意义(t=1.138,P=0.267).结论 在子宫肌瘤和子宫腺肌病经皮微波消融治疗术前及术后超声造影显示微波消融区图像变化特点鲜明,消融治疗后12~24 h内再次超声造影检查可较准确判断治疗后消融灶坏死范围.