本文選題：超聲檢查 + 介入性�。� 參考：《中國人民解放軍醫(yī)學院》2014年碩士論文

【摘要】：1目的研究超聲引導經皮微波消融治療不同類型子宮肌瘤的安全性及療效。 2資料與方法2010年2月～2014年2月，在解放軍總醫(yī)院介入超聲科接受超聲引導經皮微波消融治療的癥狀性子宮肌瘤患者，根據納入及剔除標準篩選后，入組本研究者共150例,肌瘤150枚，患者年齡30～44歲，平均（30.5±5.2）歲，肌瘤直徑3.3cm～12.5cm，平均（6.0±1.9）cm。依據不同標準將肌瘤分組1）根據治療前盆腔CE-MRI，將肌瘤按FIGO分型歸為三類：黏膜下（0～2型）；肌壁間（3～4型）；漿膜下（5～6型）；2）根據治療前盆腔CE-MRI，將肌瘤按位置分成五種類型：前壁；后壁；宮底；側壁；宮頸；3）根據瘤體均徑d將肌瘤分三種：小肌瘤：d＜5cm；中等大小肌瘤：5cm≤d＜8cm；大肌瘤：d≥8cm。結果分析：①安全性分析：依據國際介入放射治療協(xié)會針對介入治療后不良反應及并發(fā)癥制定的SIR分級評估法，將患者消融后出現的不良反應或并發(fā)癥分為A～F共6個等級，其中無任何不良反應及A、B兩級不良反應，這三種情況均視為治療安全，C、D級視為欠安全，E、F級視為不安全。1）分析治療的安全性；2）分析不同類型、不同位置、不同大小、不同消融率的肌瘤治療安全性有無差異。②臨床療效分析：通過比較治療前與治療后2年內各種指標的變化情況，分析該技術的臨床療效。本研究根據國際腫瘤治療UICC標準，擬定療效評價標準：有效為瘤體縮小，FSR≥25%，臨床癥狀及生活質量恢復至正常人水平或改善；無效為瘤體縮小，但FSR＜25%，臨床癥狀無明顯變化或嚴重。1）指標變化分析：肌瘤體積縮小率，臨床癥狀及生活質量問卷評分，患者貧血情況；2）療效分析；3）分析不同類型、不同位置、不同大小療效差異；4）肌瘤復發(fā)率。 3結果 第一章:安全性分析 1.1一般情況：黏膜下肌瘤28枚（0型6枚，1型10枚，2型12枚），肌壁間72枚（3型27枚，，4型45枚），漿膜下50枚（5型27枚，6型23枚）；前壁肌瘤50枚，后壁48枚，宮底33枚，側壁16枚，宮頸3枚；小肌瘤48枚，中等大小肌瘤83枚，大肌瘤19枚。 1.2安全性：150例患者全部順利完成消融，生命體征平穩(wěn)。超聲引導經皮微波消融治療癥狀性子宮肌瘤安全性為98.7%。 1.3治療后不良反應發(fā)生情況：150例患者治療后，148例患者為無任何不良反應或為SIRA、B級不良反應，2例患者為SIR C級。 1.4不同類型、不同位置、不同大小的子宮肌瘤之間SIR分級差異均無顯著性意義(P＞0.05)，消融率的高低與不良反應的SIR分級無明顯關系。 第二章:療效分析 2.1隨訪基本情況：本組患者隨訪3～24個月，中位隨訪時間12.5個月，平均（12.84±9.44）個月；治療后3、6、12及24個月隨訪患者分別為：131例，125例，121例及82例。 2.2療效情況：消融后第3、6、12和24個月治療后有效率分別為99.24%，99.20%，98.35%及98.78%；不同類型肌瘤相互比較，療效無差異。 2.3肌瘤體積縮小率：消融后第3、6、12和24個月，肌瘤體積縮小率分別為69.0%，82.9%，88.0%及91.1%，其中黏膜下肌瘤體積縮小最為顯著。 2.4貧血患者改善情況：治療后6個月時，除2例復發(fā)患者，其余貧血患者全部改善。 2.5患者臨床癥狀及生活質量問卷評分：消融后第3、6、12和24月時的SSS及HRQL與消融前相比,差異均有統(tǒng)計學意義。其中消融后3～6個月臨床癥狀及生活質量可恢復至正常人水平，消融后6～24個月維持在該水平無明顯變化；消融后3個月時黏膜下肌瘤SSS變化最明顯，其余時間各種類型肌瘤相比SSS及HRQL變化情況無顯著差異。 2.64年內肌瘤復發(fā)率：2例患者治療后肌瘤復發(fā)。 4結論 1．超聲引導經皮微波消融能安全治療各種類型的子宮肌瘤；不良反應的發(fā)生情況與肌瘤的類型、位置、大小、消融率無關； 2．超聲引導經皮微波消融能有效縮小肌瘤體積，其中黏膜下肌瘤體積縮小最顯著；隨著瘤體縮小，患者臨床癥狀及生活質量可在3～6個月內恢復至正常人水且并可長期維持；患者臨床癥狀改善情況與肌瘤類型無明顯關系。
[Abstract]:1 Objective To study the safety and efficacy of ultrasound-guided percutaneous microwave ablation for different types of uterine fibroids.
2 data and methods from February 2010 to February 2014, the patients with symptomatic uterine fibroids were treated by ultrasound guided percutaneous microwave ablation in the General Hospital of the PLA General Hospital. After the inclusion and elimination of the standard screening, 150 cases were enrolled in the group and 150 myoma, the patients were 30~44 years old, with an average of (30.5 + 5.2) years, the diameter of the myoma was 3.3cm to 12.5cm. The average (6 + 1.9) cm. was grouped in the myoma according to the different standards according to the different standards. According to the pre treatment pelvic CE-MRI, the myoma was classified into three categories according to the FIGO type: submucosal (0~2 type); the muscle wall (type 3~4); subserous (type 5~6); 2) divided into five types according to the anterior pelvic CE-MRI; the anterior wall; the posterior wall; the lateral wall; cervix. (3) 3) the myoma was divided into three types according to the average diameter of the tumor: small myoma: d < 5cm; medium size myoma: 5cm < d < 8cm; large myoma: analysis of d > 8cm. results: (1) safety analysis: according to the SIR grading assessment for adverse reactions and complications after interventional therapy, the occurrence of patients after ablation is not Good reactions or complications were divided into 6 grades A to F. There were no adverse reactions and A, B two adverse reactions. These three conditions were considered as the safety of treatment, C, D, E, F as unsafe.1) analysis of the safety of treatment; 2) analysis of the safety of different types, different positions, different sizes, and different ablation rates. No difference. (2) clinical efficacy analysis: the clinical efficacy of this technique was analyzed by comparing the changes of various indexes before and after 2 years after treatment. According to the UICC standard of international tumor treatment, this study drew up the standard of evaluation of curative effect: reducing the tumor body, FSR more than 25%, the clinical symptoms and the quality of life recovered to the normal level or improvement; Ineffective tumor size, but FSR < 25%, clinical symptoms without obvious changes or serious.1) index changes: myoma volume reduction, clinical symptoms and quality of life questionnaire score, patient anemia; 2) curative effect analysis; 3) analysis of different types, different positions, different size effect difference; 4) the recurrence rate of myoma.
3 Results
Chapter 1: Security Analysis
1.1 general situation: submucous myoma 28 (0 type 6, 1 type 10, 2 type 12), 72 of muscle wall (3 27, 4 45), anterior wall myoma, posterior wall, lateral wall, cervical spine, small myoma, medium myoma and myoma.
1.2 safety: 150 patients were successfully completed ablation and vital signs were stable. The safety of ultrasound-guided percutaneous microwave ablation for symptomatic uterine fibroids was 98.7%.
1.3 adverse reactions after treatment: 150 patients after treatment, 148 patients without any adverse reactions or SIRA, grade B adverse reactions, 2 patients were SIR C grade.
1.4 there was no significant difference in SIR classification between different types, different positions and different sizes of uterine leiomyoma (P > 0.05), and there was no significant relationship between the ablation rate and the SIR classification of adverse reactions.
The second chapter: analysis of curative effect
2.1 the basic situation of follow-up: the patients were followed up for 3~24 months, the median follow-up time was 12.5 months (12.84 + 9.44 months), and the patients were followed up for 3,6,12 and 24 months after treatment: 131 cases, 125 cases, 121 cases and 82 cases.
2.2 curative effect: after 3,6,12 and 24 months after ablation, the effective rate was 99.24%, 99.20%, 98.35% and 98.78%, and the different types of myoma were compared with each other, and the curative effect was no difference.
The volume reduction rate of 2.3 myoma: the volume reduction rate of myoma was 69%, 82.9%, 88% and 91.1% respectively at 3,6,12 and 24 months after ablation, and the most significant reduction in submucous myoma was the reduction of the volume of myoma.
2.4 anemia patients improvement: 6 months after treatment, in addition to 2 patients with relapse, all the other anemia patients improved.
2.5 patients' clinical symptoms and quality of life questionnaire score: SSS and HRQL at 3,6,12 and 24 months after ablation were statistically significant compared with that before ablation. In 3~6 months after ablation, the clinical symptoms and quality of life could be restored to normal level, and there was no significant change at this level for 6~24 months after ablation; and 3 months after ablation. SSS changes were most obvious in submucous myoma. There was no significant difference in SSS and HRQL in different types of myoma at other times.
Recurrence rate of myoma in 2.64 years: 2 patients relapsed after treatment.
4 Conclusion
1. ultrasound guided percutaneous microwave ablation can safely treat various types of myoma of uterus. The occurrence of adverse reactions is not related to the type, location, size, and ablation rate of the myoma.
2. ultrasound guided percutaneous microwave ablation can effectively reduce the volume of myoma, in which submucous myoma has the most significant reduction in volume. With the reduction of the tumor body, the clinical symptoms and quality of life can be recovered to normal human water within 3~6 months and can be maintained for a long time. The improvement of the clinical symptoms of the patients has no significant relationship with the type of myoma.
【學位授予單位】：中國人民解放軍醫(yī)學院
【學位級別】：碩士
【學位授予年份】：2014
【分類號】：R445.1;R737.33

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