【摘要】：研究背景： 子宮肌瘤是婦科常見病、多發(fā)病，，起源于子宮平滑肌細胞，發(fā)病原因尚不明確。子宮肌瘤可引起諸多臨床癥狀，如子宮異常出血、盆腔壓迫癥狀、流產和不孕等。高強度聚焦超聲（HIFU）是一種無創(chuàng)熱消融技術，近十幾年來在婦科臨床應用中發(fā)展迅速。它通過將超聲能量聚焦于靶肌瘤形成凝固性壞死，達到原位切除的目的。其安全性、有效性已得到證實，展示了廣闊的應用前景。 隨著HIFU消融子宮肌瘤的臨床方案及劑量學研究的進步，超聲消融子宮肌瘤的消融率有所提高、治療時間也有所縮短，尤其部分T2WI高信號或T1WI增強程度高的肌瘤已能達到滿意消融率。故目前哪些因素才是影響消融效果的重要因素仍值得探討。 目的： 1.通過單因素相關性分析，研究多種因素對HIFU消融子宮肌瘤消融率、消融效率的影響。 2.比較高強度聚焦超聲通過不同厚度脂肪及肌肉組織消融豬肉內靶點時的能量衰減情況。 資料和方法： 1.對63例子宮肌瘤患者（76個肌瘤）進行1次性HIFU治療。治療前及治療后3天內行盆腔MRI平掃及增強檢查，按照肌瘤類型、部位、最大徑、靶皮距、T2WI信號、T1WI增強程度、治療強度進行分組，在每一組內不同水平之間分別行消融率、消融效率的比較。 2.在MRI監(jiān)控下分別選擇脂肪厚度為0mm、20mm、28mm的豬肉內靶點，以輸出功率200W、輻照時間10s進行單點消融，比較相同輻照條件下所產生的凝固性壞死體積。進一步選擇脂肪厚度25mm的帶皮豬肉，將焦點置于距肌肉表面深度20mm、30mm的靶點進行單點輻照，比較相同脂肪厚度不同肌肉厚度時凝固性壞死發(fā)生情況；再選擇無皮和脂肪的豬肉，將焦點置于距肌肉表面20mm、30mm進行單點消融，比較不同肌肉厚度時凝固性壞死發(fā)生情況。 結果： 1.消融率≥70%的子宮肌瘤比例超過65%，消融效率≥50mm3/s的肌瘤比例超過56%。前壁肌瘤、子宮前位的宮底部肌瘤以及治療中超聲能量不通過一側正常子宮肌壁的側壁肌瘤消融率高于后壁肌瘤、子宮后位的宮底部肌瘤以及治療中超聲能量通過一側正常子宮肌壁的側壁肌瘤（P＜0.05）；T1WI增強程度低、中、高三組間的消融率差異有統(tǒng)計學意義（P＜0.05）；而肌瘤的類型、最大徑、靶皮距、T2WI信號、治療強度對消融率的影響均無統(tǒng)計學意義(P＞0.05)。最大徑＜5cm、≥5cm的肌瘤之間比較以及T1WI增強程度低、中、高三組間比較，消融效率差異均具有統(tǒng)計學意義（P＜0.05）；而肌瘤的類型、部位、靶皮距、T2WI信號、治療強度對消融效率的影響均無統(tǒng)計學意義(P＞0.05)。 2.隨著脂肪厚度的增加，相同輻照條件下產生凝固性壞死區(qū)體積逐漸縮��；同時隨脂肪厚度的增加，凝固性壞死區(qū)縱徑逐漸增加，而橫徑逐漸縮小。當輻照無脂肪的豬肉組織時，隨肌肉厚度的增加，損傷體積縮小。但相同厚度的脂肪組織對超聲能量的衰減大于肌肉組織。 結論： 1.子宮肌瘤的部位、T1WI增強程度對消融率有顯著影響，肌瘤的大小、T1WI增強程度對消融效率有顯著影響。 2.高強度聚焦超聲通過離體脂肪組織、肌肉組織時均有能量衰減；脂肪組織對超聲能量的衰減程度高于肌肉組織。
[Abstract]:Study Background: Hysteromyoma is a common disease of the gynaecology. It is a common disease of the uterus. It is originated from the smooth muscle cells of the uterus. The cause of the disease is not yet It is clear that uterine fibroids can cause many clinical symptoms, such as abnormal uterine bleeding, pelvic compression, abortion, and no High-intensity focused ultrasound (HIFU), a non-invasive thermal ablation technique, has been developed in the clinical application of gynecology for more than a decade. Rapid. It is achieved in situ by focusing the ultrasound energy on the target myomas to form a coagulation necrosis. Objective. The safety and effectiveness of the method have been proved, and the wide application is shown. With the progress of the clinical and dosimetry of the HIFU ablation of the uterine fibroids, the ablation rate of the ultrasonic ablation of the uterine fibroids is improved, and the treatment time is also shortened. In particular, the high signal of the T2WI or the high degree of enhancement of the T1WI can be achieved. The rate of ablation is satisfactory. So what factors are the most important factors that affect the effect of the ablation still worth Objective: To study the effect of multiple factors on the ablation of uterine fibroids by single factor correlation analysis. Effects of ablation rate and ablation efficiency. Comparison of high intensity focused ultrasound through different thickness of fat and muscle tissue pork-in-pork target Energy attenuation at the time of time. Materials and methods: 1. 63 cases of hysteromyoma Patients (76 myomas) underwent a primary HIFU treatment. Pelvic MRI plain scan and enhanced examinations were performed within 3 days prior to and after treatment, grouped by type of myoma, site, maximum diameter, target skin distance, T2WI signal, T1WI enhancement, treatment intensity, in each group The ablation rate and the ablation efficiency were compared between different levels. The target of the pork with the fat thickness of 0mm, 20mm and 28mm were selected under the control of MRI, and the output power 200W and the irradiation time 10s were single-point. Radiofrequency ablation was performed to compare the volume of coagulative necrosis produced under the same irradiation conditions. The skin pork with a fat thickness of 25 mm was further selected, and the focal point was placed on a target spot with a depth of 20 mm and 30 mm from the surface of the muscle, and a single point irradiation was performed to compare the occurrence of the coagulation necrosis when the same fat thickness was different from the thickness of the muscle; and then, No skin and fat pork, focus on the muscle surface 20mm, 30mm single point elimination The results were as follows: 1. The rate of ablation was lower than 70%. In the case of more than 65%, the proportion of myomectomy with ablation efficiency of 50mm3/ s was more than 56%. The myoma of the anterior wall, the uterine leiomyoma of the anterior position of the uterus and the ultrasonic energy in the treatment did not pass through the side wall of the normal uterine muscle wall on one side, and the ablation rate was higher than that of the posterior wall myoma, the hysteromyoma at the posterior position of the uterus, and the treatment. There was a significant difference in the ablation rate among the three groups (P <0.05), and the type of the myoma, the maximum diameter, the target skin distance, the T2WI, and the contrast between the three groups were statistically significant (P <0.05). The effect of the signal and treatment intensity on the ablation rate was not statistically significant (P> 0.05). The maximum diameter was <5cm, and the difference of the ablation efficiency was statistically significant between the three groups. (P <0.05); and the type, location, target skin distance and T2WI of the myoma The effect of the treatment intensity on the ablation efficiency was not statistically significant (P> 0.05). At the same time, with the increase of the fat thickness, the longitudinal diameter of the coagulative necrosis area is gradually increased, and the transverse diameter is gradually increased. tapering. When the fat-free pork tissue is irradiated, the thickness of the muscle increases with the thickness of the muscle, damage The volume is reduced, but the attenuation of the ultrasound energy by the same thickness of adipose tissue is greater than that of the muscle tissue. Conclusion: 1. The site of the hysteromyoma, T1WI the degree of enhancement had a significant effect on the ablation rate, the size of the myoma, the degree of enhancement of T1WI, and the ablation efficiency.
【學位授予單位】：重慶醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2014
【分類號】：R737.33

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