目的 探讨超声造影在高强度聚焦超声(HIFU)消融治疗子宫肌瘤术中的应用价值.方法 120例子宫肌瘤患者共123个肌瘤进行HIFU消融治疗,应用超声造影定量分析术前、术中及术后子宫肌瘤血供情况,指导治疗参数强度的增减,进而评估HIFU疗效.结果 115个肌瘤术后超声造影表现为中央低回声无强化的消融区,并有窄边强化,治疗前瘤体血流分级分别为Ⅰ级36个,Ⅱ级47个,Ⅲ级32个;治疗后瘤体回声明显增强,血流信号不丰富,血流分级为0级110个,Ⅰ级5个.经术后6个月复查,未见复发肿瘤组织,瘤体体积缩小≥30%,证实显著有效.另有8个消融区边缘有结节或有不规则增厚边缘强化,其中5个经病理学确认有残留存活肿瘤组织,血流分级为Ⅰ级,但瘤体体积缩小<30%,3个6个月后复查表现为增大.超声造影实时监测HIFU治疗子宫肌瘤总体有效率为93.5%.结论 超声造影能直接显示肿瘤坏死灶的血供情况,实时反映肿瘤组织坏死程度,并可通过肿瘤增强特征对组织消融的范围和能量控制提供有效的影像学依据,在HIFU消融治疗子宫肌瘤的参数设定及增效作用、疗效评价方面有较大的应用价值.%Objective To assess the value of contrast-enhanced ultrasonography in uterine fibroids ablated by HIFU. Methods One hundred and twenty patients with 123 uterine fibroids treated by HIFU were enrolled. The blood flow perfusion was analyzed preoperatively and intraoperatively by CEUS. The quantity of HIFU energy would be adjusted according to the blood supply of uterine fibroids during the procedure of HIFU therapy. The effectiveness of HIFU therapy was assessed through the postoperative CEUS.Results In 115 treated leiomyomas,postoperative CEUS showed no enhancement in the central area,but with narrow surrounding edge enhancement. In these cases,preoperative perfusion was not rich,including 110 tumors of scale 0, and 5 tumors of scaleⅠ. Followed up 6 months after ablation,no sign of tumor recurrence was found,tumor size shrinked over 30%or higher. For another 8 fibroids,nodules or irregular enhancement were found postoperatively at edges of the ablated tumor, in which,survival residual tumor tissues were confirmed in 5 tumors,their blood flow classification was scaleⅠpreoperatively. However,the volume of the tumor was reduced less than 30%. The volumes of 3 tumors were increased after 6 months. The total effective rate of HIFU therapy in uterus fibroids was 93.5% by real-time CEUS.Conclusion CEUS can evaluate the blood perfusion preoperatively,guide the therapy intraoperatively,and evaluate the effect postoperatively in uterus leiomyomas ablated by HIFU.
展开▼
