[1]许永华,陈文直. 磁共振引导高强度聚焦超声完全消融子宫肌瘤:可行性、安全性和远期疗效[J].介入放射学杂志,2014,(11):959-968.
 Yonghua Xu,Wen Zhi Chen.Complete ablation of uterine fibroids by MR guided high intensity focused ultrasound: feasibility, safety and long term outcome [J].journal interventional radiology,2014,(11):959-968.
点击复制

 磁共振引导高强度聚焦超声完全消融子宫肌瘤:可行性、安全性和远期疗效 ()

PDF下载中关闭

分享到:

《介入放射学杂志》[ISSN:1008-794X/CN:31-1796/R]

卷:
期数:
2014年11期
页码:
959-968
栏目:
非血管介入
出版日期:
2014-11-25

文章信息/Info

Title:
Complete ablation of uterine fibroids by MR guided high intensity focused ultrasound: feasibility, safety and long term outcome

作者:
许永华 陈文直
Author(s):
Yonghua Xu Wen Zhi Chen
关键词:
【关键词】 磁共振 高强度聚焦超声 子宫肌瘤 消融
文献标志码:
A
摘要:
【摘要】 目的 评估MRI引导高强度聚焦超声(MRgHIFU)完全消融子宫肌瘤的可行性、安全性和远期疗效。方法 对43例(平均年龄41.4岁)共51个子宫肌瘤,平均大小为(7.1 ± 1.4)cm,均进行一次MRI引导高强度聚焦超声消融术。治疗后即刻MRI增强测量靶肌瘤的体积及其无灌注区的体积,子宫肌瘤无灌注区的完全覆盖靶肌瘤为完全消融。对完全消融的子宫肌瘤在治疗后3个月、6个月、1年、2年和3年通过MRI进行随访复查肌瘤的体积变化;在术前、3、6个月采用UFS QOL症状评分方法对患者症状评分,并随访3年观察其症状的变化。同时对这些肌瘤的特征、治疗后不良事件、聚焦超声能量及治疗效率等进行了分析。结果 经MRgHIFU治疗后肌瘤平均消融率为84.3% ± 15.7%(范围33.8% ~ 100%),肌瘤部分消融(消融率 < 90%)、几乎完全消融(消融率为90% ~ 99%)和完全消融的病例分别为23例、10例和10例,平均治疗时间为(2.2 ± 0.8)h(范围1.0 ~ 4.3 h),治疗后均未发生并发症。10例13个完全消融的肌瘤术前MRI均为T2低信号表现而其血供类型不同;超声治疗的能效因子(EEF)为:(3.6 ± 2.1)J/mm3(0.7 ~ 6.8 J/mm3)。治疗后3、6个月症状严重程度评分(SSS)分别为从术前的33.9 ± 7.1下降至16.6 ± 9.0和 8.1 ± 3.4(P < 0.01),1年或2年后10例患者的症状完全消失。治疗后3、6个月和3年肌瘤体积分别缩小39.5% ± 10.2%、59.1% ± 9.0%和93.3% ± 3.1%(P < 0.01)。治疗后3年随访肌瘤均未出现复发。结论 MRI引导高强度聚焦超声完全消融子宫肌瘤是可行的、安全的和有效的,MRI T2WI低信号肌瘤可在治疗后取得完全消融。

参考文献/References:

[1] Dixon D, Parrott EC, Segars JH, et al. NIH congress: uterine leiomyoma research[J]. Fertil Steril, 2006, 86: 800 806.
[2] Fedele L, Parazzini F, Luchini L, et al. Recurrence of fibroids after myomectomy: a transvaginal ultrasonographic study[J]. Hum Reprod, 1995, 10: 1795 1796.
[3] Jolesz FA, Hynynen K, McDannold N, et al. MR imaging controlled focused ultrasound ablation: a noninvasive image guided surgery[J]. Magn Reson Imaging Clin N Am, 2005, 13: 545 560.
[4] Stewart EA, Gostout B, Rabinovici J, et al. Sustained relief of leiomyoma symptoms by using focused ultrasound surgery[J]. Obstet Gynecol, 2007, 110(2 Pt 1): 279 287.
[5] Burn PR, McCall JM, Chinn RJ, et al. Uterine fibroleiomyoma: MR imaging appearances before and after embolization of uerine arteries[J]. Radiology, 2000, 214: 729 734.
[6] Zhang L, Chen WZ, Liu Y, et al. Feasibility of magnetic resonance imaging guided high intensity focused[J]. Eur J Radiol, 2010, 73: 396 403
[7] Smith WJ, Upton E, Shuster EJ, et al. Patient satisfaction and disease specific quality of life after uterine artery embolization[J]. Am J Obstet Gynecol, 2004, 190: 1697 1703.
[8] Kim HS, Baik J, Pham LD, et al. MR guided high intensity focused ultrasound treatment for symptomatic uterine leiomyomata: long term outcomes[J]. Acad Radiol, 2011, 18: 970 976.
[9] Meng X., He G., Zhang J, et al. A comparative study of fibroid ablation rates using radio frequency or high intensity focused ultrasound[J]. Cardiovasc Intervent Radiol, 2010, 33: 794 799.
[10] Kark MJ, Kim Y, Keserci B, et al. Volumetric MR guided high intensity focused ultrasound ablation of uterine fibroids: treatment speed and factors influnencing speed[J]. Eur Radiol, 2013, 23: 943 950.
[11] Smart OC, Hindley JT, Regan L, et al. Gonadotropin releasing hormone and magnetic resonance guided ultrasound surgery for uterine leiomyomata[J]. Obstet Gynecol, 2006, 108: 49 54.
[12] Yamashita Y, Torashima M, Takahashi M, et al. Hyperintense uterine leiomyoma at T2 weighted MR imaging: differentiation with dynamic enhanced MR imaging and clinical implications[J]. Radiology, 1993, 189: 721 725.
[13] Swe TT. Uterine leiomyoma: correlation between signal intensity on magnetic resonance imaging and pathologic characterics[J]. Radiat Med, 1992, 10: 235 242.
[14] Stewart EA, Rabinovici J, Tempany CM, et al. Clinical outcomes of focused ultrasound surgery for the treatment of uterine fibroids[J]. Fertil Steril, 2006, 85: 22 29.
[15] McDannold N, Tempany CM, Fennessy FM, et al. Uterine leiomyomas: MR imaging based thermometry and thermal dosimetry during focused ultrasound thermal ablation[J]. Radiology, 2006, 240: 263 272.
[16] Voogt MJ, van Stralen M, Ikink ME, et al. Targeted vessel ablation for more efficient magnetic resonance guided high intensity focused ultrasound ablation of uterine fibroids[J]. Cardiovasc Intervent Radiol, 2012, 35: 1205 1210.
[17] Kim YS, Kim JH, Rhim H, et al. Volumetric MR guided high intensity focused ultrasound ablation with a one layer strategy to treat large uterine fibroids: initial clinical outcomes[J]. Radiology, 2012, 263: 600 609.
[18] Coussios C, Farny CH, Haar GT, et al. Role of acoustic cavitation in the delivery and monitoring of cancer treatment by high intensity focused ultrasound (HIFU)[J]. Int J, Hyperthermia, 2007, 23: 105 120.
[19] 许永华, 符忠祥, 杨利霞, 等. MRI导航和温度监控下高强度聚焦超声治疗子宫肌瘤[J]. 介入放射学杂志, 2010, 19: 869 874.
[20] Yu T, Luo J. Adverse events of extracorporeal ultrasound guided high intensity focused ultrasound therapy[J]. PloS ONE, 2011, 6: 26110.
[21] Lenard ZM, McDannold NJ, Fennessy FM, et al. Uterine leiomyomas: MR guided focused ultrasound therapy[J]. Radiology, 2008, 249: 187 194.
[22] LeBlang SD, Hoctor K, Steinberg FL, et al. Leiomyoma shrinkage after MRI guided focused ultrasound treatment: report of 80 patients[J]. AJR, 2010,194: 274 280.

相似文献/References:

[1]王 会,胡继红,赵 卫. 骨肿瘤的消融治疗[J].介入放射学杂志,2012,(10):879.
 WANG Hui,HU Ji- hong,ZHAO Wei.. Recent advances in ablation therapy of bone neoplasm[J].journal interventional radiology,2012,(11):879.
[2]姜 曼,赵 卫,姚瑞红,等. 高强度聚焦超声消融治疗子宫肌瘤的临床应用[J].介入放射学杂志,2013,(01):82.
 JIANG Man,ZHAO Wei,YAO Rui? hong,et al. The clinical research of high intensity focused ultrasound therapy for ablating uterine leiomyomas[J].journal interventional radiology,2013,(11):82.
[3]鲁仁财,赵 卫,易根发,等.微泡对比剂应用于高强度聚焦超声治疗子宫肌瘤疗效观察 [J].介入放射学杂志,2018,27(01):71.
 LU Rencai,ZHAO Wei,YI Gengfa,et al.The clinical application of microbubble contrast agent in high intensity focused ultrasound treatment for uterine fibroids[J].journal interventional radiology,2018,27(11):71.
[4]易根发,赵 卫,范宏杰,等.不同子宫位置子宫肌瘤的高强度聚焦超声消融效果分析[J].介入放射学杂志,2019,28(03):280.
 YI Genfa,ZHAO Wei,FAN Hongjie,et al.The influence of uterus position on HIFU ablation effect of uterine fibroids[J].journal interventional radiology,2019,28(11):280.
[5]谢璇丞,范宏杰,赵 卫,等.子宫肌瘤介入治疗现状及研究进展[J].介入放射学杂志,2019,28(09):905.
 XIE Xuancheng,FAN Hongjie,ZHAO Wei,et al.Interventional treatment of uterine fibroids: its current situation and research progress[J].journal interventional radiology,2019,28(11):905.
[6]潘文秋,汤蕊嘉,赵 卫,等.高强度聚焦超声治疗子宫肌瘤临床疗效的影响因素[J].介入放射学杂志,2019,28(11):1086.
 PAN Wenqiu,TANG Ruijia,ZHAO Wei,et al.HIFU for the treatment of uterine fibroids: analysis of the factors influencing clinical curative effect[J].journal interventional radiology,2019,28(11):1086.
[7]李 智,刘 楠,章海滨,等.1.5T封闭式超导磁共振引导经皮肝穿刺活检的临床应用[J].介入放射学杂志,2021,30(03):288.
 LI Zhi,LIU Nan,ZHANG Haibin,et al.Clinical application of 1.5T closed superconducting MR-guided percutaneous liver biopsy [J].journal interventional radiology,2021,30(11):288.
[8]阎冰洁,李 鹏,徐晓菊,等.两种不同功率高强度聚焦超声治疗子宫瘢痕妊娠的比较[J].介入放射学杂志,2021,30(06):580.
 YAN Bingjie,LI Peng,XU Xiaoju,et al.Two different power high-intensive focused ultrasound for cesarean scar pregnancy: comparison of curative effect[J].journal interventional radiology,2021,30(11):580.
[9]焦德超,王朝艳,李兆南,等.3.0T 闭合式大孔径MR引导下肝癌微波消融15例 [J].介入放射学杂志,2021,30(11):1128.
 JIAO Dechao,WANG Chaoyan,LI Zhaonan,et al.3.0T closed wide-bore MR-guided microwave ablation for hepatocellular carcinoma: preliminary experience in 15 cases[J].journal interventional radiology,2021,30(11):1128.
[10]邝岚琼,许永华,杨利霞,等.T2WI高信号子宫肌瘤信号强度比值和纹理分析预测聚焦超声消融疗效[J].介入放射学杂志,2022,31(11):1081.
 KUANG Lanqiong,XU Yonghua,YANG Lixia,et al.Application of signal intensity ratio and texture analysis in predicting the efficacy of focused ultrasound ablation for T2WI high signal hysteromyoma[J].journal interventional radiology,2022,31(11):1081.

备注/Memo

备注/Memo:
(收稿日期:2013-10-13)
(本文编辑:袁 正)
更新日期/Last Update: 2014-11-24