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目的评估容积MR引导的高强度聚焦超声(MR-HIFU)消融治疗症状性子宫肌瘤的治疗速度,以及影响治疗速度的因素。方法本研究获得机构伦理委员会的批准,所有参与者签署知情同意书。在相关的109例病人中,43例病人(39.4%,平均年龄43.7岁)的共112个肌瘤通过筛选。使用容积MR-HIFU消融术对53个症状性子宫肌瘤[47.3%,53/112,体积(341±256.5)mL]进行治疗,然后评估手术时间、无血流灌注体积(NPV)和治疗速度(NPV/治疗时间)。采用多因素回归分析对治疗速度的影响因素进行统计学分析。结果 43例病人中的42例成功接受了手术操作。MR室时间(从进入到离开)和治疗时间(从第一个到最后一个声波处理)分别为(216±40.6)min及(131.5±55.9)min。即时NPV为(178.9±147.3)mL,占肿瘤体积的(57.4±25.5)%。治疗速度为(81.8±48.0)mL/h。多因素分析表明,肿瘤体积大(P<0.001)、在T2加权成像中子宫肌瘤与骨骼肌的信号比低(P=0.009)及术者完成学习曲线后操作(P<0.001)能显著增加治疗速度。结论容积MR-HIFU消融术能有效治疗症状性子宫肌瘤,巨大的、低信号的子宫肌瘤及完成学习曲线能提高治疗速度。要点①高强度聚焦超声(HIFU)为治疗子宫肌瘤提供了另一种介入放射的选择。②容积MR引导HIFU消融能适时治疗子宫肌瘤。③巨大的、低信号的子宫肌瘤能提高治疗速度。④完成学习曲线能提高治疗速度。
Objective To assess the therapeutic rate of MR-guided high-intensity focused ultrasound (MR-HIFU) ablation for the treatment of symptomatic uterine fibroids and the factors influencing the speed of therapy. Methods The study was approved by institutional ethics committee and all participants signed informed consent form. Of the 109 patients involved, a total of 112 fibroids of 43 patients (39.4%, mean age 43.7 years) were screened. Fifty-three symptomatic uterine fibroids [47.3%, 53/112, volume (341 ± 256.5) mL] were treated with volume MR-HIFU ablation and then surgery time, volume of non-perfusion volume (NPV), and treatment rate (NPV / treatment time). Multivariate regression analysis of the factors affecting the treatment rate were statistically analyzed. Results Of the 43 patients, 42 successfully underwent surgical procedures. The MR room time (from entry to departure) and treatment time (from the first to the last sonication) were (216 ± 40.6) min and (131.5 ± 55.9) min, respectively. Immediate NPV was (178.9 ± 147.3) mL, accounting for (57.4 ± 25.5)% of tumor volume. The treatment rate was (81.8 ± 48.0) mL / h. Multivariate analysis showed that tumor volume (P <0.001) was significantly lower in T2 weighted imaging compared with low skeletal muscle (P = 0.009) and postoperative learning curve (P <0.001) Treatment speed. Conclusions Volume MR-HIFU ablation can effectively treat symptomatic uterine fibroids, huge, low-signal uterine fibroids and completion of learning curve can improve the treatment rate. Highlights ① High intensity focused ultrasound (HIFU) provides another interventional radiation option for the treatment of uterine fibroids. ② volume MR-guided HIFU ablation can timely treatment of uterine fibroids. ③ huge, low-signal uterine fibroids can increase the speed of treatment. ④ completion of the learning curve can improve the treatment rate.