子宮腺肌癥治療課件

湖北省婦幼保健院MaternityandchildcarecentersinhubeiprovinceWangYanprojectdate

20/09/2007高強度聚焦超聲治療子宮腺肌癥的臨床研究TheClinicalStudyOfUltrasound-guidedHigh-intensityFocusedUltrasoundAblationForAdenomyosis概念onception

02子宮腺肌病(adenomyosis,AM)一種常見婦科疾病，多發(fā)生在30-50歲經(jīng)產(chǎn)婦。本病的發(fā)病機制尚不清楚AdenomyosisisacommonGynecologicaldiseasethatusuallyaffectmultiparasof30-to-50year-olds.Thepathogenesisofthisdiseaseisnotclear

現(xiàn)狀：發(fā)病率升高，發(fā)病年齡呈下降趨勢,對患者生活質量的影響也越來越大Thecurrentsituation:Theincidenceratesrisedwhiletheageofonsetdeclined,theinfluenceonthequalityoflifeofpatientsaregettingmoreandmoreserious文獻資料：literature&information:可能與人工流產(chǎn)、宮內(nèi)放置節(jié)育器、輸卵管結扎、診斷性刮宮、分娩等因素相關——常損傷子宮內(nèi)膜及淺肌層，導致基底層子宮內(nèi)膜侵入子宮肌層內(nèi)生長

Adenomyosismayberelatedtothefactorsofinducedabortion、IUD、tuballigation、curettage、childbirth,etc--whichusuallydamagetheendometriumandshallowmyometrium,causedthebasallayerofendometriuminvadeintomyometrium根治性手術Radicalsurgery子宮+雙附件切除術Hysterectomyandbilateralsalpingo-oophorectomy(BSO)手術治療surgicaltreatment

保守性手術：Conservativeoperation子宮內(nèi)膜去除術（Transcervicalesectionofendometrium,TCRE）介入（UterineArterialEmbolization,UAE）腹腔鏡子宮動脈結扎術（LaparoscopicUterineArteryLigation,LBUAB）超聲聚焦治療（HighIntensityFocusedUltrasound,HIFU）電消融治療electricalablation子宮腺肌瘤挖除術myomectomyforuterinemyoma+腹腔鏡子宮動脈阻斷術（Laparoscopicuterinearteryblockage,LBUAB）+腹腔鏡子宮神經(jīng)去除術（Laparoscopyuterinenerveablation,LUNA）根治性手術：1%Radicalsurgery保守性手術：80-95%

Conservativeoperation治療方式的選擇Thechoiceoftreatments手術治療的不足之處thedefectsofsurgicaltreatment不能處理微小病灶——復發(fā)Can'tdealwiththesmalllesions-Relapse不能去除病因——復發(fā)Havebeenunabletoremovethecauses-Relapse增加患者的壓力和負擔Increasingthepressureandburdenofpatients保留子宮Preservationoftheuterus非侵入性Non-invasive不需麻醉Noanesthesia并發(fā)癥、副作用少Therewerefewsideeffectsandcomplications保留生育功能Conservefertility可重復性好Wellrepeatability理想治療方式TheidealtreatmantsHighIntensityFocusedUltrasoundAblationbyHaifu'sModelJC200skin下腹部瘢痕致明顯聲衰減或有放射治療病史Theabdomenscarledtoobviousacousticattenuationorreceivedradiationtreatment.急性感染性疾病未控制、慢性盆腔感染至盆腔器官Uncontrolledacuteinfectivedisease,thechronicpelvicinfectiontopelvicorgans.下腹部多次大手術、嚴重粘連者Reccivedrepeatedlyabdominamajorsurgerywithseriouslyadhesions.盆腔內(nèi)有金屬植入物Therearemetalimplantsinpelvic.嚴重心肺疾病史及患者不能俯臥2h者Withhistoryofseriouslypriorheartandlungdisease,inabilitytolieinapronepositionfor2hours.合并子宮外臟器內(nèi)膜異位者未納入本研究Withtheinternalorgansoftheuterusendometriosis.病例排除標準ExcludingcriterionPatientdata：accompanyingsymptoms

患者資料：伴隨癥狀Case病例數(shù)40Withsymptoms（%）出現(xiàn)癥狀率100%Lowerabdominalswellingpain下腹部脹痛88%Increasedmenses月經(jīng)量增多91%Disorderofmenstualcycle月經(jīng)周期紊亂95%Painatlumbosacralportionduringtheperiod經(jīng)期腰骶部疼痛89%預處理：皮膚脫脂、脫氣，膀胱及腸道準備pretreatment：degreasing，degassing，intestinalandbladderpreparation鎮(zhèn)靜鎮(zhèn)痛方案：芬太尼、咪唑安定Sedationandanalgesia:midazolam,fentanyl.治療前、后超聲造影Receivecontrast-enhancedultrasoundbeforeandaftertreatment.

治療方法therapeuticmethod治療參數(shù)TreatmentparameterFrequency頻率：1MHzFocallength焦距：134mmDiameteroftrasnducer治療頭直徑：220mmScanningmode掃描模式：singleexposure點掃描Thickness層面距離：4-5mmStartingpower開始功率：250w-300wMaximalpower最大功率：400w評估方法Methodsofevaluation：超聲造影contrast-enhancedultrasound

彩色超聲定期隨訪檢查（治療后1、3、6個月）Regularfollow-upbyColorDopplerSonography(aftertreatment1month,3month,6month)

臨床癥狀評分theclinicalsymptomgrades評估內(nèi)容evaluatingcontent:消融定量評估quantitativeablationevaluation

腺肌瘤及子宮消融前后聲像圖變化comparedthechangingoftheacousticimageofuterusandendometriomabeforeandaftertreatment.

臨床癥狀改善theimprovementofsymptoms腺肌病消融后的療效評估內(nèi)容Theevaluationsofefficacyafter應用超聲造影計算腺肌病的消融療效computietheeffectiveinablatingbycontrast-enhancedultrasound

病例插圖1The1thillustrationofcases

腺肌瘤體積（FV）=消融體積（NPV）=體積消融比率=NPV/FV×100%=應用超聲造影計算腺肌病的消融療效computietheeffectiveinablatingbycontrast-enhancedultrasound病例插圖3The3thillustrationofcases腺肌瘤體積（FV）=消融體積（NPV）=體積消融比率=NPV/FV×100%=治療前后各指標變化情況

Thechangeofindexsbeforeandaftertreatment結果results治療前后超聲造影檢查腺肌瘤滅活部分造影劑充盈缺損，呈無回聲 Thecontrast-enhancedultrasoundaftertreatmentshowthatnocontrastmediumandhyperechoicin

nactivatedadenomysis每個腺肌病均有不同程度的滅活，滅活率為20%～95%，平均75%左右，其中滅活率90.0%以上的腺肌瘤占37.5%(15/40)，滅活率75.0%以上的腺肌病占70%(28/40)Alltheadenoymisistherewerecertaindegreeofinactivation,thedeactivation–rateis20%-95%,theaveragedeactivation–rateabout75%,thecasesofrategreaterthan90.0%accountsfor37.5%(15/40),thecasesofrategreaterthan75.0%accountsfor70%(28/40),治療后變化Thechangeaftertreatment月經(jīng)量增多改善theimprovementofmenstruation臨床癥狀改善clinicallyimprovementinsymptoms隨訪時間follow-uptime顯效obviouseffects（%）有效effective（%）無效invalid（%）術后1月after1month3（7.5）28（70）9（22.5）術后3月after3month8（20）30（75）2（5）術后6月after6month9（22.5）29（72.5）2（5）HIFU治療后行彩超隨訪，39例患者治療中均可見腺肌瘤區(qū)域內(nèi)回聲增強，部分出現(xiàn)小的團狀強回聲Thefollow-upafterHIFUtreatmentshowthatthere39patientsthetreatareaechoesofhighamplitude,someoneappearstrongecho.影像學隨訪follow-upofImaging治療1個月：腺肌瘤體積無明顯變化，3例體積略增大，瘤體內(nèi)回聲較前增強、不均，邊界逐漸模糊，血流信號明顯減少（8例開始出現(xiàn)壞死液化）aftertreatment1month:therearenotsignificantchangeofUterinemyomavolume,3cases'volumeincreased,theechoofmyomaenhancedandunevenness.thebordersareblurringgradually,thebloodflowsignalssignificantlydecreased(Ofthe8patientswithliquefactionnecrosis)治療3個月~6個月：腺肌瘤體積逐漸縮??；血流信號稀少或未見血流信號，瘤體周邊見較細的血流信號存在aftertreatment1-3month:Uterinemyomavolumedecreasedgradually;therearefewornobloodflowsignals,therearesomesmallerbloodflowsignalspara-tumors.影像學隨訪follow-upofImagingHIFU治療子宮腺肌病的安全性ThesafetyofHIFUablaeadenomyosis治療中Durningthetreatment：

疼痛（盆腔內(nèi)治療區(qū)、骶尾部、會陰、下肢，疼痛評分2-3分，患者均訴可耐受）pain(treatmentareasinpelviccavity,Sacrococcyg