本文選題：高強度超聲聚焦 + 子宮肌瘤　； 參考：《福建中醫(yī)藥大學》2017年碩士論文

【摘要】：目的:子宮肌瘤是育齡期女性中的常見病、多發(fā)病,容易診斷,但需要個性化治療。高強度聚焦超聲(HIFU)技術為子宮肌瘤的治療提供了一種新選擇。隨著HIFU治療子宮肌瘤的發(fā)展,人們對HIFU的有效性及安全性進行深入研究,其中,子宮肌瘤大小對HIFU治療子宮肌瘤的影響尚不明確,本文旨在研究HIFU治療不同大小子宮肌瘤的療效和安全性之間的差異,為HIFU治療子宮肌瘤的篩選及預后判斷提供理論基礎。方法:本研究選擇符合入選標準2016年2月到2016年12月于四川省遂寧中心醫(yī)院行高強度超聲聚焦治療的單發(fā)子宮肌瘤患者共120例,按照肌瘤最大徑d分為以下4組,分別為第一組(1cm≤d3cm)30例、第二組(3cm≤d5cm)30例、第三組(5cm≤d7cm)30例、第四組(d≥7cm)30例,通過對比HIFU治療后的療效,包括即刻體積消融率、治療后1月、3月隨訪肌瘤縮小情況、采用子宮肌瘤癥狀嚴重程度亞量表(UFS)評價治療后3月子宮肌瘤患者癥狀緩解情況,以及治療中和治療后不良反應及并發(fā)癥,分析及評價HIFU治療四組患者的臨床療效及安全性。為進一步指導臨床實踐,優(yōu)化治療方法,預測治療療效提供客觀的理論依據(jù)。結果:1.四組患者一般臨床資料,包括年齡、BMI、腹壁厚度、肌瘤深面距骶骨距離、MRIT2信號、肌瘤位置、類型無明顯差異,具有可比性(P0.05)。2.HIFU治療劑量學參數(shù)對比,四組間治療功率無明顯差異(P0.05),而輻照時間、治療強度、總能量兩兩對比,各組之間存在差異(P0.05),隨肌瘤直徑的增大,輻照時間、治療強度、總能量呈逐漸遞增。3.所有患者均順利完成HIFU治療,各組獲得的即刻體積消融率(%)分別為 86.00±12.50、87.91±7.92、86.52±10.06、87.79±10.12,對比無統(tǒng)計學意義(P0.05)。4.四組患者術后隨訪1月子宮肌瘤縮小率(%)分別為36.59±15.74、38.73±19.22、34.84±14.82、33.66±19.66,術后 3 月分別為 53.64±8.80、56.99±21.47、51.25± 17.61、54.06±22.18,組間對比均無明顯差異(P0.05)。5.接受HIFU治療的120例患者中有癥狀子宮肌瘤患者93例,術后3月隨訪結果共有90例患者癥狀評分較術前有不同程度的下降,術后評分明顯低于術前評分(P0.01),對比四組患者的癥狀評分下降率無明顯差異(P0.05)。6.術中患者報告的不良反應有骶尾部、腹部、腹股溝、臀部疼痛,放射痛、皮膚燙,比對術中不良反應發(fā)生率無明顯差異(P0.05)。隨訪HIFU術后發(fā)生的不良反應,包括下腹部疼痛、發(fā)熱、骶尾部痛、陰道排液、皮膚損傷,其中下腹痛疼痛的發(fā)生率最高,且第一、二、三組患者的發(fā)生率均低于第四組患者(P0.05),余不良反應發(fā)生率各組間對比無統(tǒng)計學意義。根據(jù)SIR分級,術后不良反應均屬于SIRA-B級輕度不良反應,對比無顯著性差異(P0.05)。結論:1.子宮肌瘤直徑越大,高強度超聲聚焦治療子宮肌瘤的治療強度、輻照時間、總能量越多,但肌瘤大小不影響HIFU治療的近期療效和安全性。2.HIFU均能安全有效治療各種大小的子宮肌瘤,尤其對于肌瘤最大徑7cm的子宮肌瘤患者可以做為一種安全有效的治療方式。
[Abstract]:Objective: myoma of uterus is a common disease in women of childbearing age. It is frequently occurring and easy to diagnose, but it needs individualized treatment. High intensity focused ultrasound (HIFU) provides a new choice for the treatment of uterine leiomyoma. With the development of HIFU in the treatment of uterine leiomyoma, the efficacy and safety of HIFU are deeply studied, among which the hysteromyoma is large. The effect of HIFU on the treatment of uterine myoma is not clear. The purpose of this study is to study the difference between the efficacy and safety of HIFU in the treatment of different sizes of uterine leiomyoma, and to provide a theoretical basis for the screening and prognosis of HIFU for the treatment of uterine myoma. Methods: this study chose the standard of admission from February 2016 to December 2016 in the center of Suining, Sichuan province. 120 patients with single uterine myoma with high intensity ultrasound focused therapy were divided into 4 groups according to the maximum diameter D of myoma, 30 cases (1cm < d3cm), 30 cases of second (3cm < d5cm), 30 cases (5cm < d7cm), fourth group (d > 7cm) 30 cases, including the immediate volume ablation rate, and 1 after treatment by contrast HIFU. Months, March, follow-up of myoma reduction, the use of uterine leiomyoma symptom severity scale (UFS) to evaluate the symptoms of uterine myoma in March after treatment, as well as the treatment and treatment of adverse reactions and complications after treatment, analysis and evaluation of the clinical efficacy and safety of the four groups of patients treated with HIFU treatment, to further guide clinical practice and optimize the treatment of treatment. Methods to provide an objective theoretical basis for the prediction of therapeutic effect. Results: 1. the general clinical data of the four groups, including age, BMI, abdominal wall thickness, deep distance from the myoma to the sacral distance, the MRIT2 signal, the location and type of the myoma, were not significantly different. There was a comparable (P0.05).2.HIFU treatment of dosimetry parameters, and there was no significant difference in the treatment power between the four groups (P0.05). The irradiation time, the treatment intensity and the total energy were 22, and there was a difference between each group (P0.05). With the increase of the diameter of the myoma, the irradiation time, the intensity of treatment and the total energy increased gradually.3. all the patients successfully completed the HIFU treatment. The immediate volume ablation rate (%) obtained in each group was 86 + 12.50,87.91 + 7.92,86.52 + 10.06,87.79 + 10.12 respectively. The hysteromyoma reduction rate (%) in the four group of.4. four groups in January was 36.59 + 15.74,38.73 + 19.22,34.84 + 14.82,33.66 + 19.66 respectively, and 53.64 + 8.80,56.99 + 17.61,54.06 + 22.18 after operation, respectively. There was no significant difference between the groups (P0.05) in 120 cases of HIFU treatment (P0.05). 93 patients with symptomatic hysteromyoma were followed up in March. 90 patients were followed up in March. The scores of the patients were lower than those before the operation. The postoperative score was significantly lower than the preoperative score (P0.01). There was no significant difference (P0.05) in the four groups. The adverse reactions of the patients in the.6. operation were sacrococcygeal, abdominal, groin and hip pain. Pain, radiation pain, skin perm, no significant difference in the incidence of adverse reactions in comparison (P0.05). Follow up HIFU postoperative adverse reactions, including lower abdominal pain, fever, sacrococcygeal pain, vaginal discharge, skin injury, the incidence of lower abdominal pain and pain is the highest, and first, second, three groups of patients are lower than the fourth groups (P0.05), remaining (P0.05). There was no significant difference in the incidence of adverse reactions between each group. According to the SIR classification, the postoperative adverse reactions were all SIRA-B mild adverse reactions, and there was no significant difference (P0.05). Conclusion: 1. the greater the diameter of the uterine myoma, the higher intensity ultrasound focusing treatment of uterine myoma, the more radiation time, the total energy, but the size of the myoma is not a shadow. The short-term efficacy and safety of HIFU therapy can be used safely and effectively for the treatment of various sizes of uterine leiomyoma, especially for patients with the maximum diameter 7cm of myoma, which can be used as a safe and effective treatment.
【學位授予單位】：福建中醫(yī)藥大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R737.33

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