摘要目的 探讨磁共振引导聚焦超声术(MRgFUS)非侵入性消融子宫肌瘤及腺肌症的效果和安全性,并分析其差异.方法 前瞻性分析2017年2月至2018年7月于佛山市中医院拟行MRgFUS治疗的子宫肌瘤或腺肌症患者共61例(肌瘤36例,腺肌症25例),均为女性,年龄27～ 48(39±5)岁.记录治疗情况、治疗效果和术后不良反应,并比较肌瘤和腺肌症患者的差异.结果 肌瘤组和腺肌症组完成治疗者分别为32例(88.9％)和21例(84.0％)(P＞0.05).腺肌症组靶点能量为1 039～5 698(2 852±991)J,高于肌瘤组的600～6 466(2 485±1 137)J,差异有统计学意义(P＜0.01);两组的靶点温度、消融时间差异均无统计学意义(均P＞ 0.05).肌瘤组和腺肌组非灌注体积比(NPVR)分别为54％～99％(84％±15％)和60％～98％(82％±12％),差异无统计学意义(P＞0.05);腺肌症组消融效率为0.8 ～ 4.3 (2.1±0.9) cm3/min,低于肌瘤组的1.3～ 7.8 (3.6±1.5) cm3/min(P＜0.01).腺肌组术后不良反应发生率为47.6％(10/21),高于肌瘤组18.8％(6/32) (P＜ 0.05).结论 MRgFUS安全、非侵入性治疗子宫肌瘤和子宫腺肌症是可行的,均能获得较好的消融效果.相对于子宫肌瘤而言,子宫腺肌症MRgFUS治疗存在所需能量较高、消融效率较低、不良反应较多等不足之处,需要进一步进行技术优化.

abstractsObjective To investigate the feasibility and safety of magnetic resonance guided focused ultrasound surgery (MRgFUS) ablation treatment for uterine fibroids and adenomyosis.Methods From February 2017 to July 2018,a total of 61 women in Foshan Hospital of Traditional Chinese Medicine with uterine fibroids or adenomyosis (36 cases of fibroids and 25 cases of adenomyosis) were included for treatment of MRgFUS,mean age was 27-48 (39 ± 5) years.The treatment status,treatment effect and complications were recorded,and the differences between myoma and adenomyosis were compared.Results Thirty-two (88.9％) patients of fibroid group and twenty-one (84.0％) patients of adenomyosis group were completed MRgFUS treatment respectively (P＞0.05).The spot energy of adenomyosis group was 1 039-5 698 (2 852±991) J,which was higher than 600-6 466(2 485± 1 137) J of fibroid group (P ＜ 0.01).There was no significant statistical difference in mean temperature of spot and ablation time between the two groups (P＞ 0.05).The non-perfusion volume ratio (NPVR) of the fibroid and adenomyosis group was 54％-99％(84％± 15％) and 60％-98％(82％± 12％) and there was no significant statistical difference (P＞0.05),but the ablation efficiencies of adenomyosis group was less than fibroid group (0.8-4.3(2.1 ±0.9) cm3/min vs 1.3-7.8(3.6± 1.5) cm3/min,P＜ 0.01).The incidence of complications of adenomyosis group was 47.6％(10/21),it was higher than fibroid group 18.8％(6/32) (P＜0.05).Conclusions MRgFUS is a non-invasive,safe and effective treatment for both uterine fibroids and adenomyosis.Compared with uterine fibroids,MRgFUS treatment of adenomyosis has some disadvantages such as higher energy,lower ablation efficiency and more adverse reactions,and further optimization is needed.