本文選題：高強(qiáng)度聚焦超聲 + 肌壁間子宮肌瘤�。� 參考：《重慶醫(yī)科大學(xué)》2014年碩士論文

【摘要】：目的： 探討HIFU治療肌壁間子宮肌瘤與漿膜下子宮肌瘤的臨床療效及安全性有無(wú)差異。 方法： 對(duì)符合入選條件的158例肌壁間子宮肌瘤和103例漿膜下子宮肌瘤兩組患者進(jìn)行對(duì)比研究，比較兩類(lèi)肌瘤患者臨床癥狀、HIFU劑量學(xué)參數(shù)（平均聲強(qiáng)、總能量等）、治療中及治療后3天內(nèi)副反應(yīng)，以及HIFU后的療效，如體積消融率、治療后3月、6月、12月彩色多普勒超聲隨訪(fǎng)肌瘤體積縮小情況。采用癥狀嚴(yán)重程度亞量表（UFS-8）評(píng)價(jià)治療后12月子宮肌瘤隨訪(fǎng)癥狀緩解情況，并對(duì)兩組患者的變化進(jìn)行比較。觀(guān)察兩組患者的不良反應(yīng)，，評(píng)價(jià)HIFU治療兩組患者的安全性。 結(jié)果： 1.兩組患者HIFU前的年齡及臨床癥狀（月經(jīng)量增多、痛經(jīng)、尿頻、便秘及貧血）無(wú)明顯差異（P＞0.05）。治療后12月采用癥狀評(píng)分評(píng)價(jià)兩組患者的癥狀改善情況，并對(duì)兩組患者癥狀改善情況進(jìn)行比較，結(jié)果顯示兩組患者癥狀評(píng)分降低值的差異無(wú)統(tǒng)計(jì)學(xué)意義（P＞0.05），提示HIFU均能有效改善兩組患者癥狀，且改善效果無(wú)統(tǒng)計(jì)學(xué)差異。 2.所有患者均順利完成治療。肌壁間子宮肌瘤與漿膜下子宮肌瘤的平均體積、平均聲強(qiáng)、體積消融率對(duì)比無(wú)差異（P＞0.05），但輻照時(shí)間、總能量對(duì)比存在明顯差異（P＜0.01）。 3.所有患者HIFU治療中及治療后3天內(nèi)副反應(yīng)均無(wú)嚴(yán)重副反應(yīng)發(fā)生。HIFU治療中，兩組患者間骶尾部痛、治療區(qū)域痛的發(fā)生率具有統(tǒng)計(jì)學(xué)意義（P＜0.05），而放射痛、皮膚燙、腹股溝痛、臀部皺褶處疼痛及其他副反應(yīng)發(fā)生率無(wú)統(tǒng)計(jì)學(xué)意義（P＞0.05）；此外，觀(guān)察到肌壁間子宮肌瘤組患者恥骨聯(lián)合疼痛1例、肛門(mén)墜脹1例、心率和血壓降低1例，漿膜下子宮肌瘤組患者恥骨聯(lián)合上方刺痛1例。HIFU治療后3天，兩組患者間發(fā)熱、下腹部痛、骶尾部痛、下肢感覺(jué)運(yùn)動(dòng)功能異常、陰道排液、皮膚損傷等副反應(yīng)發(fā)生率無(wú)統(tǒng)計(jì)學(xué)意義（P＞0.05）；此外，觀(guān)察到肌壁間子宮肌瘤組患者血尿1例、兩側(cè)腹股溝區(qū)疼痛1例，漿膜下子宮肌瘤組小便刺痛1例。 4.評(píng)價(jià)HIFU治療后兩組患者的療效，除肌壁間子宮肌瘤組有3例臨床治療無(wú)效外，余肌瘤HIFU治療均有效。治療后3月、6月、12月隨訪(fǎng)兩組肌瘤體積均逐漸縮小，且比較兩組肌瘤體積縮小率，其差異無(wú)統(tǒng)計(jì)學(xué)意義（P＞0.05）。 結(jié)論： 1. HIFU能安全有效治療肌壁間子宮肌瘤及漿膜下子宮肌瘤，表明HIFU是肌壁間、漿膜下子宮肌瘤患者的一種可選擇的安全有效的治療方法。 2.盡管HIFU治療肌壁間子宮肌瘤較漿膜下子宮肌瘤所需輻照時(shí)間更長(zhǎng)、總能量更高，但HIFU均能有效治療兩類(lèi)肌瘤。
[Abstract]:Objective:To explore the clinical efficacy and safety of HIFU in the treatment of intramural uterine myoma and subserous uterine myoma.Methods:A comparative study was conducted between 158 patients with intramural hysteromyoma and 103 patients with subserous uterine myoma. The clinical symptoms of the two types of leiomyomas were compared with those of HIFU dosimetry parameters (mean sound intensity).Total energy isobaric, side effects during treatment and 3 days after treatment, and curative effect after HIFU, such as ablation rate of volume, 3 months, 6 months and 12 months after treatment, were followed up by color Doppler ultrasound.Symptom severity subscale (UFS-8) was used to evaluate the symptom relief of uterine leiomyoma 12 months after treatment and to compare the changes between the two groups.To observe the adverse reactions of the two groups and to evaluate the safety of HIFU in the treatment of the two groups.Results:1.There was no significant difference in age and clinical symptoms (increased menstrual volume, dysmenorrhea, frequent urination, constipation and anemia) between the two groups before HIFU (P > 0.05).Symptom scores were used to evaluate the improvement of symptoms in the two groups 12 months after treatment, and the improvement of symptoms was compared between the two groups.The results showed that there was no significant difference in symptom score between the two groups (P > 0.05). The results indicated that HIFU could effectively improve the symptoms of the two groups, and there was no significant difference in the improvement effect between the two groups.2.All patients were successfully treated.There was no significant difference in the mean volume, average sound intensity and volume ablation rate between myoma and subserous uterine myoma (P > 0.05), but there was significant difference in irradiation time and total energy (P < 0.01).3.There were no severe side effects in all patients treated with HIFU and within 3 days after treatment. The incidence of sacrococcygeal pain between the two groups was statistically significant (P < 0.05), while radiation pain, scalding skin and groin pain were found in all patients.There was no significant difference in the incidence of pain and other side effects in the rump folds (P > 0.05). In addition, one case of symphysis pubis pain, one case of anal distension, and one case of heart rate and blood pressure decrease were observed in the myoma group.One case of suprapubic prickly pain in subserous uterine leiomyoma group. 3 days after HIFU treatment, there were fever, lower abdomen pain, sacrococcygeal pain, lower extremity sensorimotor dysfunction, vaginal effusion between the two groups.There was no significant difference in the incidence of side effects such as skin injury (P > 0.05). In addition, 1 case of hematuria, 1 case of bilateral inguinal area pain and 1 case of urinal stinging pain in subserous uterine myoma group were observed in the myoma group.4.To evaluate the efficacy of HIFU in the treatment of intramural uterine leiomyoma, except for 3 cases of myoma of the muscle wall, HIFU was effective in the treatment of residual myoma.Three months, six months and twelve months after treatment, the volume of myoma in the two groups was gradually reduced, and there was no significant difference between the two groups in the reduction rate of myoma volume (P > 0.05).Conclusion:1.HIFU is a safe and effective method for the treatment of intramural myoma and subserous uterine myoma, indicating that HIFU is a safe and effective method for the treatment of myomembranous and subserous uterine leiomyoma.2.Although HIFU takes longer irradiation time and higher total energy than subserous hysteromyoma, HIFU can effectively treat both types of myoma.
【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】：2014
【分類(lèi)號(hào)】：R737.33

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