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目的评价MRI引导下聚焦超声(MRgFUS)治疗子宫肌瘤的安全性、可操作性及近期疗效。方法21例症状性子宫肌瘤患者,年龄36~47岁,平均年龄42岁;体质量指数(BMI)20.45~27.34,平均BMI 23.57。对其进行MRgFUS治疗,在治疗后即刻行子宫肌瘤增强MRI扫描,测量每例肌瘤的无灌注体积(NPV),评价治疗完整性。治疗后1周、1个月、3个月、6个月分别进行随访,统计患者症状改善及相关不良事件发生情况。每次随访均进行子宫肌瘤症状-生活质量问卷(UFS-QOL)调查,分析症状严重度评分(SSS),评价患者症状改善程度。结果对21例患者的23个子宫肌瘤进行了MRgFUS治疗,手术成功率100%,平均每例耗时230 min,平均每例肌瘤当天治疗后NPV百分比62.86%(25%~99%),术中无严重并发症发生。21例患者均接受了6个月的随访。术后6个月平均SSS降低70.63%,由术前的28.87±9.69(9.38~40.63)降至8.48±7.10(0~25),差异有统计学意义(P<0.05)。结论MRgFUS治疗子宫肌瘤安全性高,真正无创,近期疗效确切,远期疗效有待于进一步随访评价。
Objective To evaluate the safety, maneuverability and short-term curative effect of MRI-guided focused ultrasound (MRgFUS) for uterine fibroids. Methods Twenty-one patients with symptomatic uterine fibroids were aged from 36 to 47 years old with a mean age of 42 years. The body mass index (BMI) was 20.45-27.34 and the mean BMI was 23.57. They were treated with MRgFUS, and an enhanced MRI scan of uterine fibroids was performed immediately after treatment, and the non-perfusion volume (NPV) of each fibroid was measured to evaluate the treatment completeness. The patients were followed up for 1 week, 1 month, 3 months and 6 months after treatment. The patients’ symptoms were improved and the related adverse events were observed. UFS-QOL was performed for each follow-up, symptom severity score (SSS) was analyzed, and symptom improvement was evaluated. Results MRgFUS was performed on 23 uterine fibroids in 21 patients. The success rate was 100%. The average time taken for each case was 230 min. The average percentage of NPV after each fibroids treatment was 62.86% (25% -99%), No serious complications occurred during surgery. All 21 patients were followed up for 6 months. The average SSS decreased 70.63% at 6 months postoperatively from 28.87 ± 9.69 (9.38 ~ 40.63) to 8.48 ± 7.10 (0 ~ 25), the difference was statistically significant (P <0.05). Conclusion MRgFUS treatment of uterine fibroids safe, truly noninvasive, the exact effect of the recent, long-term efficacy needs further follow-up evaluation.