【摘要】：研究背景：子宮肌瘤是育齡期女性最常見疾病，約占婦科良性腫瘤的52%。目前其發(fā)病機制尚不完全清楚，但與雌激素相關(guān)。肌瘤一般多發(fā)，以肌壁間最常見，其臨床表現(xiàn)與肌瘤類型、肌瘤數(shù)目、肌瘤大小等相關(guān)，常見癥狀為經(jīng)量增多、經(jīng)期延長、尿頻尿急、貧血、下腹墜脹等，但多數(shù)患者無癥狀，常經(jīng)體檢發(fā)現(xiàn)。目前治療子宮肌瘤的方法主要包括藥物治療、手術(shù)治療及其他治療。對于無癥狀的患者，可選擇期待療法，定期隨訪，部分子宮肌瘤患者也能自然懷孕。近年來超聲消融治療作為一種非侵入性、保守性治療子宮肌瘤的方法已取得滿意的臨床療效。本實驗通過研究超聲消融對多發(fā)性子宮肌瘤的治療情況及可行性，分析影響多發(fā)性子宮肌瘤能否消融及消融率的相關(guān)因素。 目的：探討影響超聲消融治療多發(fā)性子宮肌瘤的因素。 方法：對32例多發(fā)性子宮肌瘤患者進行一次性超聲消融治療，同時記錄患者術(shù)中反應(yīng)。術(shù)后第二天所有患者均行盆腔MRI平掃+增強檢查，計算未消融肌瘤的個數(shù)，統(tǒng)計未消融肌瘤未能治療的原因，分析肌瘤能否消融與肌瘤大小、位置、類型及T2WI信號的關(guān)系。分析消融率與肌瘤大小、位置、類型及T2WI信號的關(guān)系。 結(jié)果：（1）32例多發(fā)性子宮肌瘤患者均順利完成超聲消融治療，術(shù)中均發(fā)生不適反應(yīng)，但無需治療，，無不良后果。 （2）肌瘤消融情況分析：消融前MRI檢查顯示32例患者最大徑≥10mm肌瘤共123個，術(shù)后增強MRI顯示其中91個肌瘤完全或部分無強化。肌瘤類型、位置及MRI T2WI信號與肌瘤能否消融無統(tǒng)計學(xué)意義（P＞0.05），肌瘤大小與肌瘤能否消融有統(tǒng)計學(xué)意義（P＜0.05）。 （3）消融肌瘤消融率28.6~100%，平均消融率（88.27±14.68）%。比較發(fā)現(xiàn)不同大小、類型及位置的肌瘤之間消融療效差異無統(tǒng)計學(xué)意義（P＞0.05），在MRI T2WI上不同信號的肌瘤消融療效差異有統(tǒng)計學(xué)意義（P＜0.05），T2WI低信號的肌瘤消融率最高。 結(jié)論：超聲消融治療多發(fā)性子宮肌瘤是一種安全、可行的無創(chuàng)方法，影響多發(fā)性子宮肌瘤能否消融的主要因素是肌瘤的大小。肌瘤消融率與肌瘤在MRI T2WI上不同信號相關(guān)。
[Abstract]:Background: uterine leiomyoma is the most common disease in women of childbearing age, accounting for 52% of benign gynecological tumors. At present, its pathogenesis is not completely clear, but it is related to estrogen. The clinical manifestations of myoma are related to the type of myoma, the number of myoma, the size of myoma, etc. The common symptoms are increased volume, prolonged menstrual period, frequent urination, anemia, abdominal distension and so on, but most patients are asymptomatic. It is often found by physical examination. Current treatments for uterine leiomyoma include drug therapy, surgical treatment and other treatments. For asymptomatic patients, you can choose expectant therapy, regular follow-up, some uterine fibroids can also be naturally pregnant. In recent years, ultrasound ablation as a non-invasive, conservative treatment of uterine leiomyoma has achieved satisfactory clinical results. In this study, we studied the feasibility of ultrasound ablation for multiple uterine leiomyoma, and analyzed the factors influencing the ablation rate of multiple uterine leiomyoma. Objective: to investigate the factors influencing ultrasound ablation for multiple uterine leiomyoma. Methods: 32 patients with multiple hysteromyoma were treated by one-time ultrasound ablation and the intraoperative reaction was recorded. On the second day after operation, all patients were examined by plain enhanced pelvic MRI, the number of unablated leiomyomas was calculated, the causes of unablated leiomyoma were counted, and the relationship between ablation and size, location, type and T2WI signal of leiomyoma was analyzed. To analyze the relationship between ablation rate and size, location, type and T2WI signal of leiomyoma. Results: (1) 32 patients with multiple uterine leiomyoma successfully completed ultrasound ablation. (2) Analysis of ablation status of leiomyoma: before ablation, MRI examination showed that there were 123 cases of myoma with maximum diameter 鈮

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