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目的评估分析超声介导下高强度聚焦超声(High Intensity Focused Ultrasound,HIFU)治疗子宫肌瘤的可行性、临床疗效及安全性。方法随机选取2011年12月-2015年12月在长春中医药大学附属医院行超声介导HIFU治疗子宫肌瘤患者72例,治疗后分别在1、3、6、12个月进行随访,对患者的临床症状改善情况与子宫肌瘤的二维超声、彩色多普勒血流信号及超声造影等影像学变化进行评估疗效。结果治疗后,有效随访72例患者104个子宫肌瘤。术前60例经量增多的子宫肌瘤患者,治疗后12个月症状改善者占85.0%;50例痛经的子宫肌瘤患者,治疗后12个月改善者占81.0%。随访过程中发现8例再妊娠病例。治疗后超声随访结果,72例子宫肌瘤患者104个肌瘤体积进行性缩小,第1个月整体平均缩小45.7%,第3个月缩小63.4%,第6个月缩小74.3%,第12个月缩小80.4%。治疗前、后相比超声提示肌瘤瘤体回声相对增强,瘤体彩色血流信号大部分消失;超声造影提示治疗肌瘤内无灌注。结论 HIFU是治疗子宫肌瘤的一种无创伤、安全、有效的方法,并且具有术中术后发症少,不影响患者妊娠的特点。
Objective To evaluate the feasibility, clinical efficacy and safety of ultrasound-guided High Intensity Focused Ultrasound (HIFU) in the treatment of uterine fibroids. Methods Totally 72 patients with uterine myoma treated by ultrasound-mediated HIFU in Changchun University of Traditional Chinese Medicine Hospital from December 2011 to December 2015 were randomly selected and followed up at 1, 3, 6 and 12 months after treatment, The improvement of clinical symptoms and uterine fibroids, two-dimensional ultrasound, color Doppler flow signals and ultrasound imaging and other imaging changes were evaluated. Results After treatment, effective follow-up of 72 patients with 104 uterine fibroids. Preoperative 60 patients with increased volume of uterine fibroids, 12 months after treatment, symptoms improved 85.0%; 50 cases of dysmenorrhea in patients with uterine fibroids, 12 months after treatment, improvement accounted for 81.0%. During follow-up, 8 cases of pregnancy were found. After treatment, the results of ultrasonography showed that the size of 104 fibroids in 72 cases of uterine fibroids was reduced conspicuously, the first month was reduced by 45.7% on average, the third month was reduced by 63.4%, the sixth month was reduced by 74.3%, the twelfth 80.4% reduction in the month. Compared with ultrasound before and after treatment, the echogenicity of the fibroid tumor is relatively enhanced, and most of the tumor color flow signals disappear. Contrast-enhanced ultrasound shows no perfusion in the fibroid. Conclusion HIFU is a noninvasive, safe and effective method for the treatment of uterine fibroids. It has less intraoperative and postoperative complications and does not affect the pregnancy characteristics of patients.