南方医科大学学报

南方医科大学学报 ›› 2014, Vol. 34 ›› Issue (07): 978-.

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肌壁间、粘膜下与浆膜下子宫肌瘤超声消融疗效比较及12个月随访结果

任德宏，汪伟，王旸，姚元庆，唐杰   

  • 出版日期:2014-07-20 发布日期:2014-07-20

Ultrasound-guided focused ultrasound ablation of intramural, submucosal and
subserosal uterine fibroids: 12-month follow-up results

  • Online:2014-07-20 Published:2014-07-20

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摘要： 目的比较肌壁间、粘膜下和浆膜下子宫肌瘤超声消融治疗的效果及差异。方法前瞻性研究应用超声消融治疗症状性子
宫肌瘤的疗效，用MRI评估肌瘤体积消融率及治疗后6、12个月的体积变化，使用症状严重程度评分表（SSS）评估患者临床症状
变化情况。结果2011年8月~2012年12月单中心110例患者145个肌瘤纳入本研究，其中肌壁间肌瘤72（49.7%），粘膜下肌瘤
49（33.8%），浆膜下肌瘤24（16.6%）。治疗后体积消融率分别为（93.2±13.1）%、（94.9±9.3）%和（89.6±19.3）%，不同类型肌瘤体积
消融率无统计学差异（P>0.05）。治疗后6 个月、12 个月体积分别缩小（47.3±20.8）%、（70.3±22.2）%、（47.8±13.6）%和（58.9±
19.9）%、（82.0±21.2）%、（50.5±17.8）%，粘膜下肌瘤体积缩小率大于肌壁间与浆膜下肌瘤（P<0.05）。临床症状分别以肌壁间、粘
膜下和浆膜下肌瘤为主的患者治疗前SSS评分分别为（29.1±15.2）、（34.8±14.5）、（26.6±23.4），治疗后6个月和12个月SSS评分
分别为（18.4±15.8）、（15.5±10.7）、（11.6±11.7）和（18.9±13.2）、（16.8±14.0）、（11.5±9.1），与治疗前相比差异均有统计学意义（P<
0.05）。所有患者均无严重并发症发生。结论超声消融治疗肌壁间、粘膜下和浆膜下肌瘤均获得了较高的体积消融率，术后6、
12个月随访肌瘤体积缩小和临床症状改善显著，可以为有保留子宫意愿的肌瘤患者提供一种新的治疗选择。

Abstract: Objective To evaluate the effect of ultrasound-guided focused ultrasound ablation (US-FUA) in the treatment of
intramural, submucosal and subserosal uterine fibroids. Methods We prospectively assessed the efficacy of US-FUA for
treatment of symptomatic uterine fibroids by determining the volume ablation ratio immediately after the treatment and
evaluating the volume changes of the uterine fibroids on contrast-enhanced MRI at 6 and 12 months after the treatment. The
symptom severity score (SSS) was examined before and at 6 and 12 months after the treatment. Results A total of 110 women
with 145 symptomatic fibroids undergoing US-FUA between August 2011 and December 2012 were enrolled. The fibroids
were located intramurally in 72 (49.7% ), submucosally in 49 (33.8% ) and subserosally in 24 (16.6% ) patients, who had
comparable mean volume ablation ratios [(93.2 ± 13.1)% vs (94.9 ± 9.3)% vs (89.6 ± 19.3)% , P>0.05]. The volume of the treated
fibroids was reduced by (47.3±20.8)%, (70.3±22.2)% and (47.8±13.6)% at 6 months after US-FUA and by (58.9±19.9)%, (82.0±
21.2)%, and (50.5±17.8)% at 12 months, respectively, demonstrating a more obvious volume reduction for submucosal fibroids
(P<0.05). The SSS scores of the 3 groups before treatment were 29.1±15.2, 34.8±14.5 and 26.6±23.4, respectively, which decreased
significantly to 18.4±15.8, 15.5±10.7, and 11.6±11.7 at 6 months (P<0.05) and to 18.9±13.2, 16.8±14.0, 11.5±9.1 at 12 months (P<
0.05). No major complications occurred in these patients during the 12-month follow-up. Conclusions US-FUA can yield high
ablation ratios for intramural, submucosal and subserosal fibroids and result in significant volume reduction and symptomatic
improvement at 6 and 12 months after the treatment, suggesting its value as a new noninvasive option for fibroid treatment in
patients who wish to preserve the uterus.