本文選題：評分系統(tǒng) + 高強(qiáng)度聚焦超聲　； 參考：《重慶醫(yī)科大學(xué)》2017年碩士論文

【摘要】：高強(qiáng)度聚焦超聲(High Intensity Focused Ultrasound,HIFU)是近年發(fā)展起來的一種非侵入性腫瘤治療方式。由于其創(chuàng)傷小、治療后患者恢復(fù)快、不損害卵巢功能、無輻射、無手術(shù)切口等特點(diǎn),其治療子宮肌瘤的臨床療效已受廣泛認(rèn)可。HIFU消融治療子宮肌瘤的原理是將體外低能量的超聲波聚焦于子宮肌瘤病灶內(nèi),通過機(jī)械效應(yīng)、熱效應(yīng)和空化效應(yīng)等使病灶發(fā)生不可逆性凝固性壞死,從而使子宮肌瘤失去生長功能,達(dá)到治療目的同時(shí)卻沒有損傷靶區(qū)周圍組織。在臨床應(yīng)用過程中發(fā)現(xiàn)多種因素與消融難易程度有關(guān)。研究表明:磁共振T2加權(quán)像(T2-weighted Imaging,T2WI)高信號和磁共振T1加權(quán)像(T1-weighted Imaging,T2WI)增強(qiáng)明顯強(qiáng)化的肌瘤消融治療更加困難;聲通道上的組織結(jié)構(gòu)和肌瘤大小也可影響消融效率。但是目前對各種影響因素尚未量化,也缺乏預(yù)測HIFU消融子宮肌瘤難易程度的評分系統(tǒng)。本文擬以能效因子(Energy Efficiency Factor,EEF)、輻照時(shí)間為因變量,通過分析影響EEF及輻照時(shí)間的因素,建立預(yù)測HIFU消融子宮肌瘤難易程度的評分系統(tǒng),并預(yù)測HIFU消融子宮肌瘤的輻照時(shí)間,為HIFU治療子宮肌瘤的適應(yīng)癥優(yōu)化及治療方案的完善提供依據(jù)。目的建立預(yù)測HIFU消融子宮肌瘤難易程度的評分系統(tǒng),預(yù)測HIFU消融治療子宮肌瘤的輻照時(shí)間。材料和方法(1)本研究納入2011年2月至2016年6月重慶市海扶醫(yī)院接受HIFU治療的422例子宮肌瘤患者,以EEF和輻照時(shí)間為因變量,可能影響EEF和輻照時(shí)間的因素包括年齡、體重指數(shù)、肌瘤體積、子宮位置、肌瘤類型、T2WI信號強(qiáng)度、T1WI強(qiáng)化類型、腹直肌厚度、脂肪厚度、肌瘤腹側(cè)面到皮膚的最小距離、肌瘤背側(cè)面到皮膚的最大距離、下腹壁瘢痕被設(shè)定為自變量建立最佳尺度回歸方程。(2)2016年7月-2017年3月在重慶海扶醫(yī)院接受高強(qiáng)度聚焦超聲治療的56例子宮肌瘤患者納入驗(yàn)證研究。治療前從核磁共振圖像上得到相應(yīng)變量值,然后量化變量,把量化值代入方程求出預(yù)測EEF和預(yù)測輻照時(shí)間的量化值,根據(jù)量化值查出對應(yīng)的預(yù)測值,通過比較預(yù)測EEF和預(yù)測輻照時(shí)間與真實(shí)值之間的相關(guān)性,驗(yàn)證最佳尺度回歸方程的預(yù)測效能。結(jié)果(1)肌瘤體積、T2WI信號強(qiáng)度、T1WI強(qiáng)化類型、肌瘤腹側(cè)面到皮膚的最小距離與EEF之間存在顯著相關(guān)性。T2WI信號強(qiáng)度、T1WI強(qiáng)化類型、肌瘤體積、肌瘤背側(cè)面到皮膚的最大距離與輻照時(shí)間之間存在顯著相關(guān)性。建立了能夠預(yù)測超聲消融子宮肌瘤難易程度的模型:預(yù)測EEF,y′=0.338X’_1-0.231X’_2+0.156X’_3+0.167X’_4;預(yù)測輻照時(shí)間y=0.227X_1+0.321X_2+0.157X_3+0.194X_4。(2)預(yù)測EEF量化值與EEF之間的相關(guān)性系數(shù)為0.574,預(yù)測輻照時(shí)間的量化值與輻照時(shí)間之間的相關(guān)性系數(shù)為0.665,說明能夠預(yù)測超聲消融子宮肌瘤難易程度的模型:預(yù)測EEF,y′=0.338X’1-0.231X’2+0.156X’3+0.167X’4;預(yù)測輻照時(shí)間y=0.227X1+0.321X2+0.157X3+0.194X4具有較好的預(yù)測效能。結(jié)論(1)研究結(jié)果顯示T2WI信號強(qiáng)度、T1WI強(qiáng)化類型、肌瘤體積、肌瘤腹側(cè)面到皮膚的最小距離、肌瘤背側(cè)面到皮膚的最大距離與HIFU消融子宮肌瘤難易程度相關(guān),這些因素的量化,可以預(yù)測HIFU治療子宮肌瘤難易程度并預(yù)測消融子宮肌瘤需要的輻照時(shí)間。(2)研究結(jié)果表明建立的預(yù)測超聲消融子宮肌瘤難易程度的系統(tǒng)具有較好的預(yù)測效能。
[Abstract]:High Intensity Focused Ultrasound (HIFU) is a noninvasive method of cancer treatment developed in recent years. Because of its small trauma, the patients recover quickly after treatment without damaging the ovarian function, no radiation, no surgical incision and so on. The clinical efficacy of the treatment of uterine myoma has been widely accepted by.HIFU ablation therapy. The principle of uterine myoma is to focus on the uterine leiomyoma with low energy ultrasound in vitro. It causes irreversible coagulative necrosis by mechanical effect, heat effect and cavitation effect, which causes the hysteromyoma to lose its growth function. It can not damage the surrounding tissue around the target area at the same time. It is found in the clinical application process. A variety of factors are related to the degree of ease of ablation. Studies have shown that magnetic resonance T2 weighted imaging (T2-weighted Imaging, T2WI) high signal and magnetic resonance T1 weighted image (T1-weighted Imaging, T2WI) enhanced obviously enhanced myoma ablation treatment is more difficult; the tissue structure and the size of the myoma on the acoustic channel can also affect the ablation efficiency. The influencing factors have not been quantified and there is a lack of scoring system for predicting the difficulty of HIFU ablation of uterine myoma. This paper aims to establish a scoring system for predicting the difficulty degree of the HIFU ablation of uterine myoma by using the Energy Efficiency Factor (EEF) and the irradiation time as the dependent variable, and to predict the degree of HIFU ablation and the prediction of HIFU ablation. The irradiation time of uterine myoma provides a basis for the optimization of HIFU for the treatment of uterine myoma and the improvement of the treatment scheme. Objective to establish a scoring system for predicting the difficulty of HIFU ablation of uterine myoma and to predict the irradiation time of HIFU ablation for the treatment of uterine myoma. (1) this study was included in Haifu from February 2011 to June 2016. 422 patients with uterine myoma treated by HIFU, with EEF and irradiation time as dependent variables, may affect EEF and irradiation time factors including age, body mass index, myoma volume, uterus position, myoma type, T2WI signal intensity, T1WI strengthening type, rectus abdominis thickness, fat thickness, minimal distance from the ventral side to skin of myoma, myoma, myoma The maximum distance from the dorsal side to the skin, the lower abdominal wall scar was set as the independent variable to establish the optimal regression equation. (2) 56 cases of uterine myoma received high intensity focused ultrasound in Chongqing Haifu hospital in March, July 2016, were included in the validation study. The corresponding variable values were obtained from the MRI images before treatment, and then the variables were quantified. The quantized values are replaced by the quantized values to predict the quantized values of EEF and the predicted irradiation time, and the corresponding prediction values are detected according to the quantized values. The prediction efficiency of the optimal scaling regression equation is verified by comparing the prediction of the correlation between the EEF and the predicted radiation time and the true value. Results (1) the volume of the myoma, the intensity of T2WI signal, the type of T1WI strengthening, the abdomen of the myoma. There was a significant correlation between the minimum distance from the side to the skin and EEF, and there was a significant correlation between the intensity of.T2WI signal, the type of T1WI enhancement, the volume of myoma, the maximum distance from the dorsal side of the myoma to the skin and the irradiation time. A model to predict the refractory degree of uterine myoma was established: the prediction of EEF, y '=0.338X' _1-0.231X '_2+ 0.156X '_3+0.167X' _4; prediction of irradiation time y=0.227X_1+0.321X_2+0.157X_3+0.194X_4. (2) predicted that the correlation coefficient between EEF quantization value and EEF was 0.574, and the correlation coefficient between the quantified value of irradiation time and irradiation time was 0.665, indicating a model for predicting the difficult degree of uterine fibroids with ultrasonic melting: prediction of EEF, y '=0. 338X '1-0.231X' 2+0.156X '3+0.167X' 4; prediction of irradiation time y=0.227X1+0.321X2+0.157X3+0.194X4 has good predictive efficiency. Conclusion (1) the results showed that the intensity of T2WI signal, the type of T1WI enhancement, the volume of myoma, the minimum distance from the ventral side to the skin of the myoma, the maximum distance from the lateral to the skin of the myoma, and the ablation of the uterine myoma with HIFU. The quantification of these factors can predict the difficulty of HIFU in the treatment of uterine myoma and predict the irradiation time needed for the ablation of uterine myoma. (2) the results of the study show that the system established to predict the difficulty of uterine myoma with ultrasound ablation has good predictive efficiency.
【學(xué)位授予單位】：重慶醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R737.33

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本文編號：2004883