本文選題：高強(qiáng)度聚焦超聲　切入點(diǎn)：子宮腺肌病　出處：《重慶醫(yī)科大學(xué)》2015年碩士論文

【摘要】：研究背景：子宮腺肌病是常見(jiàn)的婦科疾病之一,由于其病灶與正常肌層組織之間無(wú)包膜及明確邊界,導(dǎo)致保留子宮的治療方法面臨困境,使其成為現(xiàn)代婦產(chǎn)科學(xué)的難題。高強(qiáng)度聚焦超聲(High Intensity Focused Ultrasound, HIFU)是近年來(lái)興起的一種微無(wú)創(chuàng)治療技術(shù),已應(yīng)用于子宮腺肌病治療,可有效緩解子宮腺肌病患者痛經(jīng)、經(jīng)量增多等癥狀。腺肌病灶的血流灌注是超聲能量在靶組織內(nèi)沉積的不利因素,故術(shù)前了解子宮腺肌病灶血流灌注特征對(duì)于臨床超聲消融治療子宮腺肌病具有重要意義。微泡超聲造影劑(Ultrasound Contrast Agent, UCA)在血管中的運(yùn)動(dòng)行為特征與紅細(xì)胞相仿,其到達(dá)器官的數(shù)量及速度可反映該組織微循環(huán)血流灌注狀態(tài),上述條件為評(píng)估子宮腺肌病灶微循環(huán)血流灌注特征提供了可能。本課題利用超聲造影時(shí)間強(qiáng)度曲線(xiàn)(Time-Intensity Curve, TIC)量化評(píng)估子宮腺肌病超聲造影(Contrast Ehanced Ultrasonography, CEUS)灌注特征,初步探討超聲造影灌注特征定量指標(biāo)與高強(qiáng)度聚焦超聲消融子宮腺肌病量效關(guān)系的相關(guān)性,為超聲消融子宮腺肌病術(shù)前制定治療計(jì)劃提供依據(jù)。目的：定量分析子宮腺肌病超聲造影灌注特征,探討超聲造影灌注特征定量指標(biāo)與高強(qiáng)度聚焦超聲消融子宮腺肌病的量效關(guān)系的相關(guān)性。資料與方法：2014年10月至2015年3月于重慶海扶醫(yī)院確診為子宮腺肌病并接受HIFU治療患者24例。術(shù)前行超聲造影檢查并存儲(chǔ)圖像,定量分析超聲造影TIC并記錄增強(qiáng)時(shí)間及增強(qiáng)強(qiáng)度；術(shù)后行增強(qiáng)MRI檢查評(píng)價(jià)消融效果,計(jì)算出能效因子(Energy Effect Factor, EEF)、無(wú)灌注體積(Non-perfused Volume, NPV)。分析EEF與增強(qiáng)時(shí)間及增強(qiáng)強(qiáng)度的線(xiàn)性相關(guān)性；以EEF=10J/mm3為標(biāo)準(zhǔn)分組,比較分析A組(EEF10J/mm3)與B組(EEF≥10J/mm3)的輻照時(shí)間、治療時(shí)間、總能量、平均功率、治療強(qiáng)度、消融體積、消融效率、能效因子、增強(qiáng)時(shí)間、增強(qiáng)強(qiáng)度及術(shù)后并發(fā)癥發(fā)生率的情況。結(jié)果：所有接受超聲造影檢查及超聲消融治療的病例均未出現(xiàn)嚴(yán)重并發(fā)癥及不良反應(yīng)。能效因子與增強(qiáng)時(shí)間呈負(fù)相關(guān)相,Pearson相關(guān)系數(shù)為-0.788,具有統(tǒng)計(jì)學(xué)意義(P0.01)；能效因子與增強(qiáng)強(qiáng)度呈正相關(guān),Pearson關(guān)系數(shù)為0.744,具有統(tǒng)計(jì)學(xué)意義(P0.01)。EEF10J/mm3的患者共13例(A組),EEF≥10J/mm3的患者共11例(B組),兩組相比較,平均功率、治療強(qiáng)度及并發(fā)癥發(fā)生率差異無(wú)統(tǒng)計(jì)學(xué)意義(P0.05),增強(qiáng)時(shí)間、增強(qiáng)強(qiáng)度、輻照時(shí)間、治療時(shí)間、總能量、消融體積、消融效率、能效因子差異具有統(tǒng)計(jì)學(xué)意義(P0.05)。結(jié)論：1.超聲造影TIC可安全有效地反映子宮腺肌病灶的血流灌注特征,超聲造影增強(qiáng)時(shí)間及增強(qiáng)強(qiáng)度可定量描述子宮腺肌病的灌注特征。2.子宮腺肌病灶的超聲造影灌注增強(qiáng)時(shí)間越短、增強(qiáng)強(qiáng)度越強(qiáng),高強(qiáng)度聚焦超聲消融單位體積子宮腺肌病灶所需的超聲能量越大。
[Abstract]:Background: adenomyosis is one of the most common gynecological diseases. Because there is no capsule and clear boundary between the lesion and the normal myometrium, the treatment method of preserving uterus is faced with difficulties, which makes it a difficult problem in modern obstetrics and gynecology.High intensity focused ultrasound (HIFU) is a micro-noninvasive treatment technique developed in recent years. It has been used in the treatment of adenomyosis, which can effectively relieve dysmenorrhea and increase the amount of menstruation in patients with adenomyosis.The perfusion of adenomyoma is the unfavorable factor of ultrasonic energy deposition in the target tissue, so it is important to understand the characteristics of blood perfusion of adenomyosis before operation for clinical treatment of adenomyosis by ultrasound ablation.The movement behavior of ultrasound Contrast agent in blood vessel is similar to that of red blood cell, and the quantity and speed of reaching organ can reflect the perfusion state of microcirculation in the blood vessel.These conditions may be used to evaluate the characteristics of microcirculation perfusion in uterine adenomyoma.In this study, time-Intensity Curveity (TICs) was used to quantitatively evaluate the perfusion characteristics of Contrast Ehanced Ultrasonography (Ceus) in adenomyosis.To explore the relationship between the quantitative index of perfusion characteristics of ultrasound and the dose-effect relationship of high intensity focused ultrasound ablation of uterine adenomyosis, and to provide the basis for making the treatment plan before ultrasound ablation of uterine adenomyosis.Objective: to quantitatively analyze the perfusion characteristics of ultrasound in adenomyosis and to explore the relationship between the quantitative index of perfusion and the dose-response of high intensity focused ultrasound ablation of adenomyosis.Materials and methods: from October 2014 to March 2015, 24 patients with adenomyosis were diagnosed and treated with HIFU in Haifu Hospital of Chongqing.The enhancement time and intensity of TIC were quantitatively analyzed, and the ablation effect was evaluated by enhanced MRI after operation. The energy efficiency factors (Energy Effect Factor, EEFN, Non-perfused Volume, Non-perfused Volume, Non-perfused Volume, TIC) were calculated.The linear correlation between EEF and enhancement time and enhancement intensity was analyzed, and the irradiation time, treatment time, total energy, mean power, therapeutic intensity, ablation volume, ablation efficiency were compared between group A and group B (EEF 鈮，

本文編號(hào)：1704378