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目的探讨经皮穿刺微波凝固子宫肌瘤的有效性与安全性。方法超声引导下经皮穿刺于24例患者的27个子宫肌瘤内植入微波天线进行凝固治疗。治疗前后经皮穿刺子宫肌瘤活检组织均行病理检查。治疗过程中记录患者反应。术后随访30d,记录有无并发症及副作用。治疗前、后均行静脉超声造影及增强MRI检查,评价子宫肌瘤坏死情况及消融区周围组织结构变化。结果对24例患者的27个子宫肌瘤结节行超声引导下微波热凝固治疗。27个子宫肌瘤中13个肌壁间子宫肌瘤,11个浆膜下子宫肌瘤,3个黏膜下子宫肌瘤。子宫肌瘤结节均径2.7～8.6cm,平均(5.6±1.5)cm。子宫肌瘤体积9.8～329.0cm3,平均(111.2±80.2)cm3。治疗结束后即刻经静脉超声造影26个子宫肌瘤无造影剂充盈,1个子宫肌瘤约50%无增强,即刻行2次凝固至结节无明显增强。治疗后穿刺子宫肌瘤组织病理检查显示子宫肌瘤呈凝固性坏死。局麻患者治疗开始约100s后感下腹部热、涨,但均能耐受,停止发射微波能量后患者疼痛逐渐消失。治疗结束后22例患者无明显不适,2例感下腹部及腰部不适,无需服用止痛药,8～12h后不适感自行消失。治疗中及治疗后无一例并发症发生。治疗后全部患者当月月经来潮。结论超声引导经皮穿刺微波凝固治疗可有效灭活子宫肌瘤,子宫正常肌组织不受到破坏。经皮微波凝固子宫肌瘤有望成为子宫肌瘤保守治疗的有效方法。
Objective To investigate the effectiveness and safety of percutaneous puncture microwave coagulation of uterine fibroids. Methods Ultrasound guided percutaneous puncture in 24 patients with 27 uterine fibroids implanted microwave antenna coagulation therapy. Percutaneous uterine fibroids before and after treatment biopsy were performed pathological examination. Patient response was recorded during treatment. After 30 days of follow-up, no complications and side effects were recorded. Before and after treatment, intravenous contrast enhanced ultrasound and MRI examination to assess the status of uterine fibroids necrosis and changes around the ablation zone tissue structure. Results Twenty-four uterine fibroids in 24 patients underwent ultrasound guided microwave thermocoagulation. 27 uterine fibroids in 13 myometrial uterine fibroids, 11 subserosal uterine fibroids, 3 submucosal uterine fibroids. Uterine fibroids nodules were 2.7 ~ 8.6cm in diameter, with an average (5.6 ± 1.5) cm. Uterine fibroids volume 9.8 ~ 329.0cm3, the average (111.2 ± 80.2) cm3. Immediately after treatment, intravenous contrast ultrasound 26 uterine fibroids without contrast filling, a uterine fibroids about 50% without enhancement, immediately 2 times to coagulation nodules no significant increase. After treatment, histopathological examination of uterine fibroids showed coagulation necrosis of uterine fibroids. Local anesthesia patients began to feel about 100s after the start of the lower abdomen heat, up, but can tolerate, stop the emission of microwave energy pain disappeared. After treatment, 22 patients had no obvious discomfort, 2 patients felt abdominal and lumbar discomfort, without taking painkillers, discomfort disappeared after 8 ~ 12h. No complications occurred during and after treatment. After treatment, all patients with menstrual cramps that month. Conclusion Ultrasound guided percutaneous microwave coagulation therapy can effectively inactivate uterine fibroids, normal uterine muscle is not damaged. Percutaneous microwave coagulation of uterine fibroids is expected to be an effective method of conservative treatment of uterine fibroids.