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目的评价超声引导下的高强度聚焦超声消融治疗黏膜下肌瘤的安全性和有效性。材料与方法共76名妇女患78个子宫黏膜下肌瘤(68个Ⅱ型,10个Ⅰ型)接受了超声引导下的高强度聚焦超声的消融治疗。治疗前子宫肌瘤的直径为2.4～13.5cm,平均(5.7±2.3)cm。使用420～520W的输出功率对子宫肌瘤进行消融治疗。在随访过程中,采用对比增强MRI和(或)对比增强超声对被消融后子宫肌瘤的体积萎缩情况进行连续观察。使用症状严重程度的问卷评分对症状变化进行评估。结果所有病人对高强度聚焦超声消融治疗耐受性良好。没有出现严重的并发症。对比增强超声检查中,平均无灌注的消融率为(80±12)%。随访期间,消融后的肌瘤明显萎缩,症状明显缓解。没有病人在治疗后出现闭经。在消融治疗后,58%(44/76)的病人出现阴道排出坏死组织,这个现象在2～4个月经周期后消失。4例病人由于残余肌瘤增大而再次接受消融治疗。结论超声引导下的高强度聚焦超声消融术是一种治疗黏膜下肌瘤的安全有效的方法,但对生育的影响还需要进一步的研究。
Objective To evaluate the safety and effectiveness of ultrasound-guided high-intensity focused ultrasound ablation of submucosal fibroids. Materials and Methods A total of 76 women with uterine fibroids (68 type II, 10 type I) underwent 78 patients undergoing ultrasound-guided high-intensity focused ultrasound ablation. Uterine fibroids before treatment diameter of 2.4 ~ 13.5cm, with an average (5.7 ± 2.3) cm. The use of 420 ~ 520W output power of uterine fibroids ablation. During the follow-up, the contrast-enhanced MRI and / or contrast-enhanced ultrasound were used to observe the volume shrinkage of uterine fibroids after ablation. Symptom changes were assessed using a questionnaire score of symptom severity. Results All patients were well tolerated by high intensity focused ultrasound ablation. No serious complications occurred. In contrast enhanced ultrasound, the mean non-perfusion ablation rate was (80 ± 12)%. During the follow-up period, the fibroids after ablation were obviously atrophied and the symptoms were relieved. No patient had amenorrhea after treatment. Vaginal discharge of necrotic tissue occurred in 58% (44/76) of patients after ablation, a phenomenon that disappeared after 2 to 4 menstrual cycles. 4 patients again due to residual fibroids and ablation treatment again. Conclusion Ultrasound-guided high-intensity focused ultrasound ablation is a safe and effective method for the treatment of submucosal fibroids. However, further studies on the effects of ultrasound on fertility are needed.