子宫腺肌症治疗ppt课件

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1、湖北省妇幼保健院湖北省妇幼保健院Maternity and child care centers in hubei province王燕王燕Wang Yanproject date 20/09/2007高强度聚焦超声治疗子宫腺肌高强度聚焦超声治疗子宫腺肌症的临床研究症的临床研究The Clinical Study Of Ultrasound-guided High-intensity Focused UltrasoundAblation For Adenomyosis湖北省妇幼保健院project date 20/09/2001概念概念onception 02子宫腺肌病(adenomyosis

2、,AM)一种常见妇科疾病，多发生在30-50岁经产妇。本病的发病机制尚不清楚Adenomyosis is a common Gynecological disease that usually affect multiparas of 30-to-50 year-olds.The pathogenesis of this disease is not clear 现状：发病率升高，发病年龄呈下降趋势,对患者生活质量的影响也越来越大The current situation:The incidence rates rised while the age of onset declined,the

3、 influence on the quality of life of patients are getting more and more serious 概念onception 02子宫腺肌病(adenomyos2文献资料：文献资料：literature&information:可能与人工流产、宫内放置节育器、输卵管结扎、诊断性刮宫、分娩等因素相关常损伤子宫内膜及浅肌层，导致基底层子宫内膜侵入子宫肌层内生长Adenomyosis may be related to the factors of induced abortion、IUD、tubal ligation、curettage、c

4、hildbirth,etc-which usually damage the endometrium and shallow myometrium,caused the basal layer of endometrium invade into myometrium 文献资料：3观察 observation 手术治疗 surgery药物治疗 drugs治疗治疗therapy 症状Symptoms 年龄 Age生育要求Desire of fertility,观察治疗therapy 症状4根治性手术根治性手术Radical surgery 子宫+双附件切除术Hysterectomy and bi

5、lateral salpingo-oophorectomy(BSO)手术治疗手术治疗surgical treatment 保守性手术：保守性手术：Conservative operation 子宫内膜去除术（Transcervical esection of endometrium,TCRE）介入（Uterine Arterial Embolization,UAE）腹腔镜子宫动脉结扎术（Laparoscopic Uterine Artery Ligation,LBUAB）超声聚焦治疗（High Intensity Focused Ultrasound,HIFU）电消融治疗electrical

6、ablation子宫腺肌瘤挖除术myomectomy for uterine myoma +腹腔镜子宫动脉阻断术（Laparoscopic uterine artery blockage,LBUAB）+腹腔镜子宫神经去除术（Laparoscopy uterine nerve ablation,LUNA）根治性手术手术治疗surgical treatment 保守5根治性手术：1%Radical surgery保守性手术：80-95%Conservative operation治疗方式的选择治疗方式的选择The choice of treatments根治性手术：1%治疗方式的选择6手术治疗的不

7、足之处手术治疗的不足之处the defects of surgical treatment 不能处理微小病灶复发Cant deal with the small lesions-Relapse 不能去除病因复发Have been unable to remove the causes-Relapse增加患者的压力和负担Increasing the pressure and burdenof patients 手术治疗的不足之处不能处理微小病灶复发增加患者的压力和7保留子宫Preservation of the uterus 非侵入性 Non-invasive 不需麻醉No anesthesia

8、 并发症、副作用少There were few side effects and complications保留生育功能Conserve fertility 可重复性好Well repeatability理想治疗方式理想治疗方式The ideal treatmants保留子宫Preservation of the uterus8研究方法研究方法 Research methods 研究方法9High Intensity Focused Ultrasound Ablation by Haifus Model JC200skinHigh Intensity Focused Ultraso10非月经期

9、、非妊娠期、非哺乳期Non-menstrual，un-pregnant，nonpuerperal women.经妇检和B超确定为子宫腺肌病患者Gynecological examination and Type-B ultrasonic scan evidence of typical features of adenomyosis.所有病例均有渐进性痛经、经量增多、经期延长以及下腹部坠胀、腰酸、腹痛等症状All the cases with the clinical symptoms of progressive dysmenorrhea,menorrhagia,menostaxis,nex

10、t abdominal pain and swelling,lumbar acid,abdominal pain.无实施镇静镇痛的禁忌证，治疗前均签署知情同意书同意超声消融治疗Without the contraindications to sedative and analgesic,sign a consent form before treatment.病例选择病例选择case selection 非月经期、非妊娠期、非哺乳期病例选择11下腹部瘢痕致明显声衰减或有放射治疗病史 The abdomen scar led to obvious acoustic attenuation or

11、received radiation treatment.急性感染性疾病未控制、慢性盆腔感染至盆腔器官 Uncontrolled acute infective disease,the chronic pelvic infection to pelvic organs.下腹部多次大手术、严重粘连者 Reccived repeatedly abdomina major surgery with seriously adhesions.盆腔内有金属植入物 There are metal implants in pelvic.严重心肺疾病史及患者不能俯卧2h者 With history of ser

12、iously prior heart and lung disease,inability to lie in a prone position for 2 hours.合并子宫外脏器内膜异位者未纳入本研究 With the internal organs of the uterus endometriosis.病例排除标准病例排除标准Excluding criterion下腹部瘢痕致明显声衰减或有放射治疗病史病例排除标准12Patient data：Characteristics病例基本资料病例基本资料Cases病例数病例数40Age（median）：years old年龄：（岁）27-49

13、（37.9）Number（Uterine myoma+adenomyosis）病灶数（子宫腺肌瘤+子宫腺肌病）37Number（adenomyosis）病灶数（子宫腺肌病）3Anterior/Posterior/Both前壁/后壁/前后壁11/15/14Maximal dia.（mean）最大径（厘米）2.5-8.4cmPatient data：Characteristics病13Patient data：accompanying symptoms患者资料：伴随症状患者资料：伴随症状Case病例数病例数40With symptoms（%）出现症状率 100%Lower abdominal sw

14、elling pain下腹部胀痛88%Increased menses月经量增多91%Disorder of menstual cycle月经周期紊乱95%Pain at lumbosacral portion during the period经期腰骶部疼痛89%Patient data：accompanying symp14预处理：皮肤脱脂、脱气，膀胱及肠道准备pretreatment：degreasing，degassing，intestinal and bladder preparation镇静镇痛方案：芬太尼、咪唑安定 Sedation and analgesia:midazolam

15、,fentanyl.治疗前、后超声造影 Receive contrast-enhanced ultrasound before and after treatment.治疗方法治疗方法therapeutic method预处理：皮肤脱脂、脱气，膀胱及肠道准备治疗方法15治疗参数治疗参数Treatment parameterFrequency频率：1MHzFocal length焦距：134mmDiameter of trasnducer 治疗头直径：220mmScanning mode扫描模式：single exposure点扫描 Thickness 层面距离：4-5mmStarting po

16、wer 开始功率：250w-300wMaximal power 最大功率：400w治疗参数Frequency频率：1MHz16评估方法 Methods of evaluation：超声造影 contrast-enhanced ultrasound 彩色超声定期随访检查（治疗后1、3、6个月）Regular follow-up by Color Doppler Sonography (after treatment 1month,3month,6month)临床症状评分the clinical symptom grades评估内容evaluating content:消融定量评估 quantit

17、ative ablation evaluation 腺肌瘤及子宫消融前后声像图变化 compared the changing of the acoustic image of uterus and endometrioma before and after treatment.临床症状改善the improvement of symptoms 腺肌病消融后的疗效评估内容腺肌病消融后的疗效评估内容The evaluations of efficacy after 评估方法 Methods of evaluation：腺肌病17应用超声造影计算腺肌病的消融疗效computie the effec

18、tive in ablating by contrast-enhanced ultrasound 病例插图1 The 1th illustration of cases 腺肌瘤体积（FV）=消融体积（NPV）=体积消融比率=NPV/FV100%=应用超声造影计算腺肌病的消融疗效病例插图1 腺肌瘤体积（FV18应用超声造影计算腺肌病的消融疗效应用超声造影计算腺肌病的消融疗效computie the effective in ablating by contrast-enhanced ultrasound病例插图2The 2th illustration of cases腺肌瘤体积（FV）=消融体

19、积（NPV）=体积消融比率=NPV/FV100%=应用超声造影计算腺肌病的消融疗效病例插图2腺肌瘤体积（FV）19应用超声造影计算腺肌病的消融疗效应用超声造影计算腺肌病的消融疗效computie the effective in ablating by contrast-enhanced ultrasound病例插图3The 3th illustration of cases腺肌瘤体积（FV）=消融体积（NPV）=体积消融比率=NPV/FV100%=应用超声造影计算腺肌病的消融疗效病例插图3腺肌瘤体积（FV）20治疗前后各指标变化情况治疗前后各指标变化情况 The change of inde

20、xs before and after treatment结果结果results治疗前后各指标变化情况 The change of in21 在40例腺肌病患者中，32例(80%)治疗后即刻出现团块状灰度变化，5例(12.5%)出现整体灰度变化，3例(7.5%)治疗中未观察到灰度变化In the 40 case of adenomysis,there are 32cases(80%)appeared lumpish grayscale change immediately after treatment,32cases(80%)appeared lumpish lumpish change i

21、mmediately after treatment,5cases(12.5%)appeared holistic grayscale change immediately after treatment,treatment,3cases(7.5%)did not appeare grayscale change immediately after treatment.治疗后变化治疗后变化The change after treatment 在40例腺肌病患者中，32例(80%)治疗后即刻出现团块状22治疗前后超声造影检查腺肌瘤灭活部分造影剂充盈缺损，呈无回声 The contrast-enh

22、anced ultrasound after treatment show that no contrast medium and hyperechoic in nactivated adenomysis 每个腺肌病均有不同程度的灭活，灭活率为20%95%，平均75%左右，其中灭活率90.0%以上的腺肌瘤占37.5%(15/40)，灭活率75.0%以上的腺肌病占70%(28/40)All the adenoymisis there were certain degree of inactivation,the deactivation rate is 20%-95%,the average d

23、eactivation rate about 75%,the cases of rate greater than 90.0%accounts for 37.5%(15/40),the cases of rate greater than 75.0%accounts for 70%(28/40),治疗后变化治疗后变化The change after treatment治疗前后超声造影检查腺肌瘤灭活部分造影剂充盈缺损，呈无回声治23月经量增多改善月经量增多改善 the improvement of menstruation临床症状改善临床症状改善clinically improvement in

24、 symptoms随访时间follow-up time显效obvious effects（%）有效effective（%）无效 invalid（%）术后1月after 1 month3（7.5）28（70）9（22.5）术后3月after3 month8（20）30（75）2（5）术后6月after 6 month9（22.5）29（72.5）2（5）月经量增多改善 the improvement of men24痛经症状改善痛经症状改善the improvement of dysmenorrhea临床症状改善临床症状改善clinically improvement in symptoms随访

25、时间follow-up time显效（%）有效（%）无效（%）术后1月after 1 month6（15）30（75）4（10）术后3月after3 month18（45）21（52.5）1（2.5）术后6月after 6 month21（52.5）17（42.5）2（5）痛经症状改善the improvement of dysme25HIFU治疗后行彩超随访，39例患者治疗中均可见腺肌瘤区域内回声增强，部分出现小的团状强回声The follow-up after HIFU treatment show that there 39 patients the treat area echoes

26、of high amplitude,some one appear strong echo.影像学随访影像学随访follow-up of ImagingHIFU治疗后行彩超随访，39例患者治疗中均可见腺肌瘤区域内26治疗1个月：腺肌瘤体积无明显变化，3例体积略增大，瘤体内回声较前增强、不均，边界逐渐模糊，血流信号明显减少（8例开始出现坏死液化）after treatment 1month:there are not significant change of Uterine myoma volume,3 cases volume increased,the echo of myoma enha

27、nced and unevenness.the borders are blurring gradually,the blood flow signals significantly decreased(Of the 8 patients with liquefaction necrosis)治疗3个月6个月：腺肌瘤体积逐渐缩小；血流信号稀少或未见血流信号，瘤体周边见较细的血流信号存在after treatment 1-3month:Uterine myoma volume decreased gradually;there are few or no blood flow signals,t

28、here are some smaller blood flow signals para-tumors.影像学随访影像学随访follow-up of Imaging治疗1个月：腺肌瘤体积无明显变化，3例体积略增大，瘤体内回声27HIFU治疗子宫腺肌病的安全性治疗子宫腺肌病的安全性The safety of HIFU ablae adenomyosis治疗中Durning the treatment：疼痛（盆腔内治疗区、骶尾部、会阴、下肢，疼痛评分2-3分，患者均诉可耐受）pain(treatment areas in pelvic cavity,Sacrococcygeal region,p

29、erineum,legs,pain score was 2-3 points,all the patients could tolerance.)皮肤灼伤：未见 Skin Burns:noHIFU治疗子宫腺肌病的安全性治疗中Durning the28治疗后after treatment：骶尾部胀痛2例（治疗次日既缓解）Sacrococcygeal region pain 2 case(disapperd next day)治疗区皮肤压痛3例（2-4天即缓解）pressing pain of the skin of treatment area(disapperd in 2-4 days)皮肤水

30、泡（未见）no skin hydroncus bubble ache 下肢痛麻（未见）no leg pain 低热1例（治疗次日即消失）low-grade fever 1case(disapperd the next day)阴道流血流液3例（1-2周即好转）vaginal bleeding or discharge(recurred in 1-2 weeks)肠穿孔（未见）no enterobrosis 亚急性盆腔炎（消融后1月-3月出现，经期抗炎既缓解）Subacute pelvic inflammation(appear after ablation in 1-3 month)HIFU治

31、疗子宫腺肌病的安全性治疗子宫腺肌病的安全性治疗后after treatment：HIFU治疗子宫腺肌29HIFU治疗子宫腺肌病能显著改善患者临床症状（月经过多、贫血等）HIFU ablation addenomyosis could markedly improve the clinical symptoms(menorrhagia,anemia).HIFU可有望成为治疗子宫腺肌病的一种非创伤性、疗效确切、可保留子宫、维持妇女正常生理功能的全新手段HIFU could be a noninvasive and effective brand-new means of treating aden

32、omyosis which could reserved uterine and maintain women physiological functions.小结小结brief summaryHIFU治疗子宫腺肌病能显著改善患者临床症状（月经过多、贫血30大样本、长时间的随访观察Large sample,long-term follow-up复发情况及相应的治疗措施Relapse and corresponding treatment中长期的不良反应medium-and long-term side-effect对生育功能的影响等 the effection of fertility下步研究方向下步研究方向Next Research Direction大样本、长时间的随访观察下步研究方向31谢谢32