本文選題：子宮肌瘤　切入點：縮宮素　出處：《中國人民解放軍醫(yī)學院》2014年碩士論文　論文類型：學位論文

【摘要】：研究背景： 子宮肌瘤是育齡期婦女最常見的良性腫瘤，常因引起月經(jīng)異常、盆腔壓迫等癥狀或?qū)颊呱斐刹涣加绊懚枰R床干預(yù)。隨著社會的發(fā)展和醫(yī)學的不斷進步，更多的肌瘤患者希望在治療肌瘤的同時能夠保留子宮甚至生育能力。超聲消融治療子宮肌瘤安全、有效，且具有非侵入性、術(shù)后恢復(fù)快、可門診治療等優(yōu)點，為有保留子宮意愿的肌瘤患者提供了一種新的治療選擇�？s宮素是有效的子宮收縮劑，已有研究證實縮宮素能使肌瘤內(nèi)部及周邊滋養(yǎng)血管血流頻譜發(fā)生變化并明顯降低超聲消融子宮肌瘤輻照單點溫度升高所需的能量和時間，預(yù)示縮宮素可能通過對肌瘤血流灌注產(chǎn)生影響進而提高超聲消融子宮肌瘤的效率。 目的： 1.比較子宮肌瘤患者使用縮宮素前后肌瘤血流灌注的變化。 2.探討縮宮素輔助超聲消融子宮肌瘤的作用。 資料和方法： 1.縮宮素對子宮肌瘤血流灌注的影響（自身前后對照研究）：分別于使用縮宮素前后對肌瘤進行超聲造影檢查，動態(tài)觀察子宮肌瘤的血流灌注變化，對肉眼未觀察到顯著變化的患者增加劑量再次觀察。使用軟件對造影圖像進行脫機分析，繪制時間-強度曲線，得出反映肌瘤灌注的各項定量參數(shù)。 2.縮宮素輔助超聲消融子宮肌瘤的作用（隨機對照研究）：將符合入組條件的子宮肌瘤患者按就診順序隨機分為2組，實驗組治療中使用微量泵靜脈持續(xù)泵入縮宮素，對照組泵入生理鹽水，治療后通過增強核磁或超聲造影檢查比較兩組患者消融療效的差異。 結(jié)果： 1.縮宮素對子宮肌瘤血流灌注的影響：共52例患者54枚肌瘤納入研究，，其中48例患者50(92.6%)枚肌瘤靜脈給予低劑量(0.1U/min)縮宮素15分鐘后肌瘤血流灌注參數(shù)變化顯著，用藥前肌瘤達峰時間(TTP)、峰值強度(Imax(%))、平均渡越時間(MTT)分別為(15.8±4.9)s、(108.8±69.8)%、(73.4±34.4)s，使用縮宮素后分別為(31.4±19.7)s、(17.1±20.4)%、(130.1±121.6)s，肌瘤TTP和MTT顯著延長，Imax(%)顯著降低，差異具有統(tǒng)計學意義(P0.05)。4例患者低劑量縮宮素肌瘤血流灌注肉眼未觀察到顯著變化，增加劑量至0.4U/min(高劑量)后再次觀察，用藥前、低劑量和高劑量縮宮素后肌瘤平均Imax(%)分別為(125.0±18.2)%、(103.9±37.5)%、(86.4±11.4)%。 2.縮宮素輔助超聲消融子宮肌瘤的作用：共17例患者17枚核磁T2低信號肌瘤納入研究，縮宮素組10例，對照組7例。 (1.)兩組患者平均年齡分別為(36.3±5.6)歲和(39.7±2.9)歲,(P=0.196)；肌瘤均徑分別為(64.2±8.9)cm和(61.3±8.7)cm,(P=0.525)；腹壁厚度分別為(23.0±4.3)mm和(27.8±5.1)mm,(P0.05)；腹壁皮膚距肌瘤最深面距離分別為(92.3±12.6)mm和(94.1±14.0)mm,(P=0.896)，以上指標均無統(tǒng)計學差異。 (2.)縮宮素組和對照組消融單位體積肌瘤所需能量分別為(4.8±1.6)J/mm3和(7.5±1.9)J/mm3，(P=0.007)；肌瘤平均消融率分別為(88.5±11.8)%和(69.2±15.9)%，(P=0.01)；單位體積肌瘤輻照時間分別為(9.2±3.3)s/cm3和(12.6±4.6)s/cm3,(P=0.09)�？s宮素組消融單位體積肌瘤所需能量顯著低于對照組而肌瘤消融率顯著高于對照組，差異具有統(tǒng)計學意義，單位體積肌瘤輻照時間無統(tǒng)計學差異。 結(jié)論： 子宮肌瘤患者持續(xù)靜滴0.1U/min劑量的縮宮素可顯著減少大部分肌瘤(50/54)的血流灌注，在超聲消融子宮肌瘤時使用可以顯著降低消融所需能量，提高消融率。
[Abstract]:Research background:
Uterine leiomyoma is the most common benign tumor in women of childbearing age, often caused by abnormal menstruation, pelvic compression and other symptoms or adverse effects on the fertility of patients and the need for clinical intervention. With the development of society and medicine, more hope to be able to retain the uterus myoma and fertility while treating myoma. Ultrasound ablation treatment uterine fibroids safe, effective, and non intrusive, fast postoperative recovery, but outpatient treatment etc., and provides a new treatment option for patients with myoma of uterus retaining intention. Oxytocin is effective uterine contraction agent, studies have confirmed that oxytocin can nourish blood vessels within and around the myoma the spectrum changes and a significant decrease of ultrasound ablation for uterine fibroids by single point temperature increased energy and time required, indicate that oxytocin may produce effects on fibroids perfusion The efficiency of ultrasonic ablation of myoma of uterus was further improved.
Objective:
1. compare the changes of blood perfusion of myoma in the patients with uterine myoma before and after the use of oxytocin.
2. to investigate the role of oxytocin assisted ultrasound ablation of uterine myoma.
Information and methods:
1. effect of oxytocin on uterine fibroids perfusion (self control study): respectively using oxytocin before and after the myoma were examined by CEUS, dynamic perfusion changes of uterine fibroids, to the naked eye is not observed significant changes with increasing dose again observation. Use the software for offline analysis contrast image. The rendering time intensity curve, can reflect the quantitative parameters of fibroids perfusion.
2. oxytocin assisted ultrasound ablation for uterine leiomyoma (randomized controlled trials): eligible patients of uterine fibroids were randomly divided into 2 groups, the use of micro pump intravenous infusion of oxytocin treatment in experimental group, the control group is pumped into the saline, difference after treatment by enhanced magnetic resonance or contrast-enhanced ultrasound ablation were compared between the two groups.
Result錛

本文編號：1622763