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目的探讨高强度聚焦超声(HIFU)治疗子宫肌瘤的有效性。方法选择33例妇科确诊为子宫肌瘤的患者进行HIFU治疗。HIFU治疗3个月后对非手术患者行彩色多普勒超声随诊,观察子宫肌瘤内部回声、血供及瘤体体积改变;对手术患者行MRI增强扫描,观察HIFU治疗24h后肌瘤内有无出现坏死及其病理改变。结果33例中8例HIFU治疗24h后行增强MRI扫描及手术切除术,子宫肌瘤标本中均显示靶区坏死,坏死范围与治疗范围相近。光镜下显示HIFU治疗后肌瘤内细胞变性坏死、核浓染、固缩,并见肌瘤内微血管破坏。25例非手术患者治疗后3～16个月随诊观察,23例临床症状减轻或消失,超声显示4例治疗显效,子宫肌瘤消失;19例治疗有效。患者子宫肌瘤体积缩小(约20.1%～94.3%);2例(2/25)治疗无效。13例(13/33)HIFU治疗后出现一过性神经刺激等症状,2例出现皮肤I度烫伤,未经任何治疗次日自行消退,未出现其他不良反应。结论HIFU治疗子宫肌瘤有效,安全性好,但远期疗效尚需长期随访观察。
Objective To investigate the effectiveness of high intensity focused ultrasound (HIFU) in the treatment of uterine fibroids. Methods 33 patients with gynecological diagnosis of uterine fibroids were treated with HIFU. HIFU treatment for 3 months after non-surgical patients underwent color Doppler ultrasound follow-up, observation of uterine fibroids internal echo, blood supply and tumor volume changes; surgery patients underwent MRI enhanced scanning 24h after HIFU treatment fibroids Whether there is necrosis and pathological changes. Results Of the 33 cases, 8 cases of HIFU were treated with enhanced MRI scan and surgical resection. The specimens of uterine fibroids showed necrosis and necrosis within the range of treatment. Light microscopy showed HIFU fibroids within the cell after degeneration and necrosis, nuclear staining, shrinkage, and see the fibrovascular destruction. Twenty-five non-surgical patients were followed up from 3 to 16 months after treatment. The clinical symptoms of 23 cases were reduced or disappeared. Four cases were cured by ultrasound and the uterine fibroids disappeared. Nineteen cases were effective. Patients with uterine fibroids shrink (about 20.1% ~ 94.3%); 2 cases (2/25) treatment is invalid. Thirteen (13/33) patients experienced transient neurological stimulation after HIFU treatment. Two cases of skin I degree scald had spontaneous regression without any other treatment and no other adverse reactions occurred. Conclusion HIFU treatment of uterine fibroids effective and safe, but the long-term efficacy still need long-term follow-up observation.