本文選題：子宮肌瘤 + 高強(qiáng)度聚焦超聲��； 參考：《重慶醫(yī)科大學(xué)》2016年碩士論文

【摘要】：目的:子宮肌瘤的超聲造影(Contrast-enhanced ultrasound,CEUS)灌注特性與肌瘤血供相關(guān),本研究根據(jù)子宮肌瘤超聲造影達(dá)峰值時(shí)的灌注特性的不同進(jìn)行分組,通過比較其行高強(qiáng)度聚焦超聲(High intensity focused ultrasound,HIFU)消融治療后消融率、能效因子(Energy efficiency factor,EEF)、消融效率、治療時(shí)疼痛發(fā)生率及疼痛評(píng)分的差異,探討導(dǎo)致消融療效、能效因子、消融效率、治療時(shí)疼痛發(fā)生率及疼痛評(píng)分存在差異的可能性因素,為HIFU消融治療子宮肌瘤的療效進(jìn)行預(yù)判,為指導(dǎo)臨床適應(yīng)癥優(yōu)化提供依據(jù)。方法:根據(jù)接受HIFU治療的62例子宮肌瘤患者行超聲造影檢查灌注達(dá)峰值時(shí)的圖像特征的類型分為兩組:均勻高增強(qiáng)組和非均勻高增強(qiáng)組。比較兩組的平均功率、治療時(shí)間、輻照時(shí)間、治療強(qiáng)度、能效因子、消融率、消融效率、治療時(shí)疼痛發(fā)生率及疼痛評(píng)分。結(jié)果:62例子宮肌瘤患者在超聲造影過程中顯影達(dá)到峰值時(shí),其中30例表現(xiàn)為整個(gè)病灶呈均勻高增強(qiáng),接近子宮正常肌層的增強(qiáng)時(shí)間和水平,為均勻高增強(qiáng)組;另32例中部分表現(xiàn)為不均勻增強(qiáng),其余部分患者表現(xiàn)為均勻增強(qiáng)但增強(qiáng)強(qiáng)度明顯弱于正常子宮肌層,為非均勻高增強(qiáng)組。hifu消融治療后均勻高增強(qiáng)組和非均勻高增強(qiáng)組的平均消融率分別為68(范圍:13-98)%和77.6(范圍:57-99)%,非均勻高增強(qiáng)組明顯高于均勻高增強(qiáng)組(p0.05)。均勻高增強(qiáng)組和非均勻高增強(qiáng)組的能效因子分別為10(范圍:2.3-90.1)j/mm3和2.9(范圍:0.4-8.7)j/mm3,非均勻高增強(qiáng)組明顯低于均勻高增強(qiáng)組(p0.05)。均勻高增強(qiáng)組和非均勻高增強(qiáng)組的平均消融效率分別為50.7(范圍:2.6-121.9)mm3/s和150.7(范圍:32.2-635.9)mm3/s,兩者之間有顯著差異(p0.05)。均勻高增強(qiáng)組子宮肌瘤患者疼痛評(píng)分為3.7±0.7分(范圍:3-6分),而非均勻高增強(qiáng)組子宮肌瘤患者疼痛評(píng)分為2.6±0.7分(范圍:2-4分),兩組之間存在顯著差異(p0.05)。均勻高增強(qiáng)組子宮肌瘤患者治療區(qū)疼痛、皮膚燙、骶尾部疼痛及下肢放射痛的發(fā)生率均高于非均勻高增強(qiáng)組子宮肌瘤患者(p0.05)。而兩組患者的腹股溝疼痛和臀部褶皺區(qū)疼痛無顯著差異(p0.05)。結(jié)論:本研究中,超聲造影灌注達(dá)峰值時(shí)呈均勻高增強(qiáng)類型的子宮肌瘤患者和呈非均勻高增強(qiáng)類型的子宮肌瘤患者接受hifu消融治療均安全有效,而均勻高增強(qiáng)組比非均高增強(qiáng)組子宮肌瘤hifu消融困難,hifu消融治療后消融率較低,hifu消融治療時(shí)患者疼痛發(fā)生率及疼痛評(píng)分較高。子宮肌瘤超聲造影灌注特性可用于預(yù)測(cè)hifu消融治療子宮肌瘤的消融療效,值得更深入的研究。
[Abstract]:Objective: the perfusion characteristics of hysteromyoma with Contrast-enhanced ultrasound usus were correlated with the blood supply of hysteromyoma. By comparing the ablation rate, energy efficiency factor, ablation efficiency, pain incidence and pain score after high intensity focused ultrasound (HIFU) ablation, the effects of ablation, energy efficiency factors and ablation efficiency were discussed. The possible factors of the difference in pain incidence and pain score during the treatment provided a basis for guiding the optimization of clinical indications for the treatment of uterine leiomyoma by HIFU ablation. Methods: 62 patients with uterine leiomyoma treated with HIFU were divided into two groups: homogeneous high enhancement group and non uniform high contrast enhancement group. The mean power, treatment time, irradiation time, therapeutic intensity, energy efficiency factor, ablation rate, ablation efficiency, pain incidence and pain score were compared between the two groups. Results in 62 cases of uterine leiomyoma, the enhancement time and level of the normal myometrium were similar to that of the normal myometrium in 30 of the 62 cases with hysteromyoma. In the other 32 cases, some of them showed uneven enhancement, others showed homogeneous enhancement, but the intensity of enhancement was significantly weaker than that of normal uterine myometrium. The average ablation rate was 68% (range: 13-98%) and 77.6% (range: 57-99%) in the homogeneous high enhancement group and non-uniform high enhancement group after ablation treatment. The average ablation rate of the non-uniform high enhancement group was significantly higher than that of the homogeneous high enhancement group (P 0.05), and that of the non-uniform high enhancement group was significantly higher than that of the homogeneous high enhancement group (P < 0.05). The energy efficiency factors of homogeneous high enhancement group and non uniform high enhancement group were 10 (range: 2.3-90.1 g / mm3 and 2.9) (range: 0.4-8.7 J / m ~ (3), respectively). The energy efficiency factor of non-uniform high enhancement group was significantly lower than that of homogeneous high enhancement group (P 0.05). The average ablation efficiency was 50.7 (range: 2.6-121.9 mm 3 / s) and 150.7 (range: 32.2-635.9 mm 3 / s, respectively) in homogeneous high enhancement group and non-uniform high enhancement group. There was significant difference between the two groups (p 0.05). The pain score of hysteromyoma patients in homogeneous high enhancement group was 3.7 鹵0.7 (range: 3-6), while that in non-homogeneous high enhancement group was 2.6 鹵0.7 (range 2-4). There was a significant difference between the two groups (p 0.05). The incidence of pain, skin ironing, sacrococcygeal pain and lower extremity radiation pain in patients with uterine leiomyoma in homogeneous and high enhancement group was higher than that in patients with uterine leiomyoma in non-uniform high enhancement group (P 0.05). There was no significant difference in groin pain and hip fold pain between the two groups (p 0.05). Conclusion: in this study, hifu ablation is safe and effective in patients with hysteromyoma with homogeneous and high enhancement at peak perfusion. However, the ablation rate of hifu ablation difficulty in homogeneous high enhancement group was lower than that in non-uniform high enhancement group. The incidence of pain and pain score were higher in patients with homogeneous and high enhancement than those in non-uniform enhancement group. The characteristics of ultrasound perfusion in uterine leiomyoma can be used to predict the ablation effect of hifu ablation for uterine leiomyoma, which is worthy of further study.
【學(xué)位授予單位】：重慶醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2016
【分類號(hào)】：R445.1;R737.33

【參考文獻(xiàn)】

相關(guān)期刊論文 前10條

1 Mearini Luigi;;High intensity focused ultrasound,liver disease and bridging therapy[J];World Journal of Gastroenterology;2013年43期

2 嚴(yán)昆;;超聲造影在肝癌消融術(shù)后的應(yīng)用價(jià)值[J];臨床肝膽病雜志;2013年08期

3 金慧佩;余方芳;趙雅萍;鄒春鵬;林小瑜;黃品同;;不同因素對(duì)子宮肌瘤HIFU治療療效影響的初步分析[J];溫州醫(yī)學(xué)院學(xué)報(bào);2013年06期

4 羅孝勇;雒大健;向彥霖;陳康;陳宇;吳杭;;超聲造影評(píng)價(jià)射頻消融治療肝癌的療效[J];臨床超聲醫(yī)學(xué)雜志;2013年01期

5 姚南;楊麗春;陳海濤;;超聲造影在肝癌射頻消融前后應(yīng)用價(jià)值的評(píng)價(jià)[J];臨床超聲醫(yī)學(xué)雜志;2012年11期

6 胡亮;陳文直;陳錦云;彭松;張煉;黎克全;唐良萏;白晉;王智彪;;超聲消融鄰近骶尾部子宮肌瘤的臨床策略及其安全性的隨機(jī)對(duì)照研究[J];重慶醫(yī)科大學(xué)學(xué)報(bào);2012年01期

7 陳敏山;;肝癌射頻消融治療的現(xiàn)狀與展望[J];中華普通外科學(xué)文獻(xiàn)(電子版);2011年06期

8 盧峻;佘志紅;熊奕;王慧芳;甘晗靖;林琪;吳瑛;;子宮肌瘤與子宮腺肌癥超聲造影強(qiáng)化形式的臨床應(yīng)用[J];放射學(xué)實(shí)踐;2011年08期

9 李國(guó)政;苑敏;吳子芳;劉增強(qiáng);劉麗艷;;子宮肌瘤與子宮腺肌病超聲造影鑒別診斷的價(jià)值[J];首都醫(yī)科大學(xué)學(xué)報(bào);2011年02期

10 袁惠;王丹;牛錦東;邢豫賓;;超聲造影對(duì)肝癌射頻微創(chuàng)治療的應(yīng)用價(jià)值[J];中國(guó)臨床醫(yī)學(xué)影像雜志;2010年09期

相關(guān)博士學(xué)位論文 前1條

1 趙文鵬;超聲消融MRI-T2WI高信號(hào)子宮肌瘤的安全有效性研究[D];重慶醫(yī)科大學(xué);2013年

，

本文編號(hào)：1810189