超聲造影劑聯(lián)合HIFU治療不同直徑子宮肌瘤的增效作用研究
發(fā)布時間：2018-11-02 18:10
【摘要】：研究背景:子宮肌瘤屬于女性生殖系統(tǒng)疾病,多發(fā)于育齡期年齡階段的女性,其發(fā)病原因尚未完全研究明確。子宮肌瘤的大小和生長部位很大程度上影響其臨床癥狀,主要表現(xiàn)為經(jīng)量增多、經(jīng)期延長、周期不規(guī)律、下腹疼痛、盆腔壓迫導致尿頻等。高強度聚焦超聲(HⅠgh IntensⅠty Focused Ultrasound,HIFU)這項近年來為臨床提供一種可精確定位、沒有皮膚切口的無創(chuàng)治療方法,目前,已經(jīng)廣泛應用于乳腺、子宮、肝、腎、胰腺等各部位的良、惡性實體腫瘤的治療[1]。HIFU是一種非侵入性的物理治療手段,絕大多數(shù)患者術后創(chuàng)傷小,術后恢復叫有創(chuàng)手術快,同時也保留了自身的器官的完整性,以上的特點讓HIFU技術慢慢的成為廣大女性患者治療子宮肌瘤的新選擇。超聲造影劑(Ultrasound contrast agent,UCA)是一類能夠顯著增強超聲背向散射強度的化學制劑,其主要成分是微氣泡,故我們也可簡稱其微泡。最早的超聲造影劑是通過手振生理鹽水獲得,僅能顯示右心系統(tǒng)顯像,研究證明超聲造影劑可增強HIFU的手術消融效果,可作為HIFU的增效劑,但是在使用過程中存在最主要的一個問題是超聲造影劑在體內的代謝時間較短,對于較大的腫瘤,治療效果不滿意,人們發(fā)現(xiàn)通過靜脈持續(xù)泵入微泡可以解決這個問題,但其安全使用劑量又令人擔憂,那么反過來我們也許能理解為超聲造影劑對不同大小的腫瘤的增效作用也不一樣。目的:比較研究術前使用微泡超聲造影劑(聲諾維)與術前未使用超聲造影劑,聯(lián)合hⅠfu治療不同直徑子宮肌瘤的增效作用。材料和方法:1.回顧性分析2015年1月-2015年12月在遂寧市中心醫(yī)院診段單發(fā)性子宮肌瘤并接受hⅠfu治療的患者。根據(jù)其術前mrⅠ的直徑劃分為Ⅰ、Ⅱ、Ⅲ組,其中直徑3cm為Ⅰ組,3cm≤直徑≤5cm為Ⅰ組,直徑5cm為Ⅲ組。本研究共150例患者,每組50例患者,每組均選擇25例術前及術后造影患者作為造影組;選擇25例術前未造影,僅術后造影患者作為未造影組。2.比較治療過程中造影組及對照組的子宮肌瘤治療時間、輻照時間、能效因子、消融率、術中副反應發(fā)生率等治療劑量參數(shù)。結果:1.在Ⅰ組中,術前造影及術前未造影的治療時間范圍的p值為0.034,有統(tǒng)計學差異。余術前造影及術前未造影術前造影的平均功率為、eef、消融率、消融體積、團塊出現(xiàn)時間、團塊出現(xiàn)時間、輻照時間、治療強度、治療劑量,其p值均大于0.05,均無明顯差異。在Ⅱ組中,術前造影及術前未造影的輻照時間、eef、消融體積的p值分別是0.041、0.018、0.029,輻照時間、eef及消融體積存在統(tǒng)計學差異。余術前造影及術前未造影術的治療時間、平均功率為、消融率、團塊出現(xiàn)時間、團塊出現(xiàn)率、治療強度、治療劑量,其p值均大于0.05,均無明顯差異。在Ⅲ組中,術前造影與術前未造影在平均功率、輻照時間、eef、治療時間、消融率、團塊出現(xiàn)時間、團塊出現(xiàn)率、治療強度、治療劑量,其p值均大于0.05,均無明顯差異。2.Ⅰ組、Ⅲ組中術前造影劑組與術前未造影組在放射痛、骶尾部痛、皮膚燙、治療區(qū)痛、腹股溝痛、臀部皺褶痛的p值均大于0.05,均無統(tǒng)計學差異;Ⅱ組中術前造影及未造影在放射痛發(fā)生率對比中,p值為0.004,有統(tǒng)計學差異,余下組中術前造影劑組與術前未造影組在骶尾部痛、皮膚燙、治療區(qū)痛、腹股溝痛、臀部皺褶痛的發(fā)生率的p值均大于0.05,無統(tǒng)計學差異。結論:1.在超聲造影劑對小于3cm的肌瘤及大于5cm的肌瘤的增效作用不明顯,可能對3~5cm的子宮肌瘤的有一定的增效作用,所以子宮肌瘤的大小不是影響超聲增效的強弱的主要因素。2.本研究Ⅰ、Ⅱ、Ⅲ組不同大小的子宮肌瘤中,術前造影及未造影的副反應發(fā)生率無顯著性差異,且所有研究患者中均未出現(xiàn)嚴重并發(fā)癥,所以術前超聲造影結合hⅠfu治療子宮肌瘤是有安全保障的。
[Abstract]:Background: Uterine leiomyoma belongs to the female reproductive system disease, multiple in the age of childbearing age, the cause of the disease has not been completely studied. The size and growth of uterine leiomyoma affected its clinical symptoms to a large extent, mainly manifested by increased amount, prolonged menstrual period, irregular period, lower abdominal pain, pelvic pressure, and so on. High Intensity Focused Ultrasound (HIFU) has been widely used in the fields of breast, uterus, liver, kidney, pancreas, etc. Treatment of malignant solid tumors[1]. HIFU is a kind of non-invasive physical therapy means, the majority of patients have less post-operative trauma, the post-operative recovery is called invasive surgery, and the integrity of its own organs is preserved, and the above features allow the HIFU technology to gradually become a new choice for the treatment of hysteromyoma by women with large numbers of women. Ultrasound contrast agent (UCA) is a kind of chemical preparation which can significantly enhance the intensity of ultrasonic backscatter. The earliest ultrasonic contrast agent is obtained by hand vibration physiological saline, and only the right heart system imaging can be displayed, and the research proves that the ultrasonic contrast agent can enhance the surgical ablation effect of HIFU, and can be used as a synergist of HIFU, but the most important problem in the use process is that the metabolic time of the ultrasound contrast agent in the body is short, the treatment effect is not satisfactory for larger tumors, it has been found that the problem can be solved by continuously pumping the micro-bubbles through the vein, but the safe use dose is also worrying, In turn, we may be able to understand that ultrasound contrast agents do not have the same synergistic effect on different sizes of tumors. Objective: To compare the synergistic effect of microvesicle ultrasound contrast agent (SonoVue) before and before operation in the treatment of myomectomy with different diameters without using ultrasound contrast agent. Materials and Methods: 1. Retrospective analysis was conducted in January 2015 to December 2015 in patients with solitary uterine fibroids diagnosed in central hospital of Suining City and treated with h I fu. According to the pre-operative mr 鈪，
本文編號：2306560
[Abstract]:Background: Uterine leiomyoma belongs to the female reproductive system disease, multiple in the age of childbearing age, the cause of the disease has not been completely studied. The size and growth of uterine leiomyoma affected its clinical symptoms to a large extent, mainly manifested by increased amount, prolonged menstrual period, irregular period, lower abdominal pain, pelvic pressure, and so on. High Intensity Focused Ultrasound (HIFU) has been widely used in the fields of breast, uterus, liver, kidney, pancreas, etc. Treatment of malignant solid tumors[1]. HIFU is a kind of non-invasive physical therapy means, the majority of patients have less post-operative trauma, the post-operative recovery is called invasive surgery, and the integrity of its own organs is preserved, and the above features allow the HIFU technology to gradually become a new choice for the treatment of hysteromyoma by women with large numbers of women. Ultrasound contrast agent (UCA) is a kind of chemical preparation which can significantly enhance the intensity of ultrasonic backscatter. The earliest ultrasonic contrast agent is obtained by hand vibration physiological saline, and only the right heart system imaging can be displayed, and the research proves that the ultrasonic contrast agent can enhance the surgical ablation effect of HIFU, and can be used as a synergist of HIFU, but the most important problem in the use process is that the metabolic time of the ultrasound contrast agent in the body is short, the treatment effect is not satisfactory for larger tumors, it has been found that the problem can be solved by continuously pumping the micro-bubbles through the vein, but the safe use dose is also worrying, In turn, we may be able to understand that ultrasound contrast agents do not have the same synergistic effect on different sizes of tumors. Objective: To compare the synergistic effect of microvesicle ultrasound contrast agent (SonoVue) before and before operation in the treatment of myomectomy with different diameters without using ultrasound contrast agent. Materials and Methods: 1. Retrospective analysis was conducted in January 2015 to December 2015 in patients with solitary uterine fibroids diagnosed in central hospital of Suining City and treated with h I fu. According to the pre-operative mr 鈪，
本文編號：2306560
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