超声造影剂对超声消融单发子宫肌瘤增效作用的临床观察
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摘要
目的:根据患者个体差异性,探讨适合不同患者所需的造影剂注入后行高强度聚焦超声(high intensity focused ultrasound,HIFU)消融的增效最佳时机。方法:前瞻性研究109例单发子宫肌瘤患者,在超声引导下行HIFU消融治疗,按照患者住院号尾数的单双数进行非随机分组,单数纳入造影组,于HIFU术前行SonoVue超声造影,当超声监控下观察到微泡开始进入靶区时即刻开始HIFU治疗;双数纳入对照组,术前无造影检查,仅行HIFU治疗。对HIFU治疗术中与术后的各项数据进行分析比较。结果:造影组与对照组的消融率均到达70%以上,而造影组的平均功率、治疗时间、辐照时间、总能量、能效因子均明显降低(P<0.05)。与既往研究相比,超声治疗剂量和辐照时间明显降低。2组患者经消融术后,不良反应发生率均无统计学差异。术后3个月的随访调查发现部分患者肌瘤有所吸收,临床症状得到缓解。结论:在造影剂微泡开始进入靶区后立即行HIFU消融治疗能在满足个体差异性的情况下起到最强的增效作用,达到精准、高效的消融目的。
Objective:To ascertain the best time to improve the efficiency of high-intensity focused ultrasound(HIFU)ablation,according to the individual differences between patients. Methods:In a prospective study,109 patients with single uterine myoma were treated with HIFU ablation under ultrasound guidance. Patients were divided into groups according to their admission number:the single number was included in the ultrasound contrast group,and the SonoVue procedure was performed before HIFU. When the microbubbles began to enter the target area under ultrasonic monitoring,HIFU ablation was immediately initiated. In contrast,patients in the control group underwent no preoperative angiography and were only treated with HIFU ablation. Data from the HIFU treatment and after surgery were analyzed and compared between the groups. Results:The ablation rate of the CEUS group and control group was more than 70%. Average sonication power,treatment time,sonication time,total energy,and energy efficiency factor were significantly lower in the CEUS group compared to the control group(P<0.05). Dosage and irradiation time of the ultrasound treatment were significantly reduced compared with that in previous studies. Additionally,no major adverse events occurred after the ablation treatment in both groups. After three months of follow-up investigation,the myomas had healed and the clinical symptoms were alleviated in some patients. Conclusion:Immediately after the contrast medium enters the target area,HIFU ablation has the strongest synergistic effect in addressing the individual differences and achieving precise and efficient ablation in different patients.
Objective:To ascertain the best time to improve the efficiency of high-intensity focused ultrasound(HIFU)ablation,according to the individual differences between patients. Methods:In a prospective study,109 patients with single uterine myoma were treated with HIFU ablation under ultrasound guidance. Patients were divided into groups according to their admission number:the single number was included in the ultrasound contrast group,and the SonoVue procedure was performed before HIFU. When the microbubbles began to enter the target area under ultrasonic monitoring,HIFU ablation was immediately initiated. In contrast,patients in the control group underwent no preoperative angiography and were only treated with HIFU ablation. Data from the HIFU treatment and after surgery were analyzed and compared between the groups. Results:The ablation rate of the CEUS group and control group was more than 70%. Average sonication power,treatment time,sonication time,total energy,and energy efficiency factor were significantly lower in the CEUS group compared to the control group(P<0.05). Dosage and irradiation time of the ultrasound treatment were significantly reduced compared with that in previous studies. Additionally,no major adverse events occurred after the ablation treatment in both groups. After three months of follow-up investigation,the myomas had healed and the clinical symptoms were alleviated in some patients. Conclusion:Immediately after the contrast medium enters the target area,HIFU ablation has the strongest synergistic effect in addressing the individual differences and achieving precise and efficient ablation in different patients.
引文
[1]张英,华克勤.子宫肌瘤的处理与妊娠相关性[J].中国实用妇科与产科杂志,2016,32(2):135-139.
[2]郑献红.腹腔镜下子宫肌瘤剔除术与高强度聚焦超声治疗子宫肌瘤的临床疗效比较[J].实用癌症杂志,2017,32(7):1186-1188.
[3]王运来.超声造影的临床应用与前景[J].中医药管理杂志,2015,23(17):149-150.
[4]Isern J,Pessarrodona A,Rodriguez J,et al.Using microbubble sonographic contrast agent to enhance the effect of high intensity focused ultrasound for the treatment of uterine fibroids[J].Ultrasonics Sonochemistry,2015,27:688-693.
[5]Jiang N,Xie B,Zhang X,et al.Enhancing ablation effects of a microbubble-enhancing contrast agent(“SonoVue”)in the treatment of uterine fibroids with high-intensity focused ultrasound:a randomized controlled trial[J].Cardiovasc Intervent Radiol,2014,37(5):1321-1328.
[6]蒋红,罗爽,何敏,等.HIFU联合超声微泡增效剂SonoVue治疗盆腔手术史子宫肌瘤患者研究[J].昆明医科大学学报,2013,34(9):58-62.
[7]Peng S,Xiong Y,Li K,et al.Clinical utility of a microbubble-enhancing contrast(“SonoVue”)in treatment of uterine fibroids with high intensity focused ultrasound:a retrospective study[J].Eur J Radiol,2012,81(12):3832-3838.
[8]章雅琴,何炜,李丛蕊,等.兔肝VX-2肿瘤磁共振灌注扫描与超声造影增强特征及其时相划分的对比研究[J].中国医学影像学杂志,2011,19(12):942-945.
[9]Saito K,Hirai T,Ueno S.Transcranial contrast-enhanced ultrasonography with Sonazoid in semiquantitative evaluation of brain perfusion[J].J Med Ultrason,2013,40(2):133-139.
[10]杨艳.丙泊酚、芬太尼复合小剂量咪达唑仑静脉麻醉在妇产科手术中的应用价值[J].世界临床医学,2016,10(12):131-132.
[11]王文平,魏瑞雪,丁红,等.肝肿瘤实时超声造影的时相分析[J].中国医学影像技术,2003,19(12):1682-1684.
[2]郑献红.腹腔镜下子宫肌瘤剔除术与高强度聚焦超声治疗子宫肌瘤的临床疗效比较[J].实用癌症杂志,2017,32(7):1186-1188.
[3]王运来.超声造影的临床应用与前景[J].中医药管理杂志,2015,23(17):149-150.
[4]Isern J,Pessarrodona A,Rodriguez J,et al.Using microbubble sonographic contrast agent to enhance the effect of high intensity focused ultrasound for the treatment of uterine fibroids[J].Ultrasonics Sonochemistry,2015,27:688-693.
[5]Jiang N,Xie B,Zhang X,et al.Enhancing ablation effects of a microbubble-enhancing contrast agent(“SonoVue”)in the treatment of uterine fibroids with high-intensity focused ultrasound:a randomized controlled trial[J].Cardiovasc Intervent Radiol,2014,37(5):1321-1328.
[6]蒋红,罗爽,何敏,等.HIFU联合超声微泡增效剂SonoVue治疗盆腔手术史子宫肌瘤患者研究[J].昆明医科大学学报,2013,34(9):58-62.
[7]Peng S,Xiong Y,Li K,et al.Clinical utility of a microbubble-enhancing contrast(“SonoVue”)in treatment of uterine fibroids with high intensity focused ultrasound:a retrospective study[J].Eur J Radiol,2012,81(12):3832-3838.
[8]章雅琴,何炜,李丛蕊,等.兔肝VX-2肿瘤磁共振灌注扫描与超声造影增强特征及其时相划分的对比研究[J].中国医学影像学杂志,2011,19(12):942-945.
[9]Saito K,Hirai T,Ueno S.Transcranial contrast-enhanced ultrasonography with Sonazoid in semiquantitative evaluation of brain perfusion[J].J Med Ultrason,2013,40(2):133-139.
[10]杨艳.丙泊酚、芬太尼复合小剂量咪达唑仑静脉麻醉在妇产科手术中的应用价值[J].世界临床医学,2016,10(12):131-132.
[11]王文平,魏瑞雪,丁红,等.肝肿瘤实时超声造影的时相分析[J].中国医学影像技术,2003,19(12):1682-1684.
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