| Background:Uterine flesh tumour is one of the most common benign tumor of female reproductive organs, which seriously affect women’s health. The traditional surgery for symptomatic uterine fibroids damages the integrity of organs and brings a long recovery period which increases the family economic burden. Furthermore the high recurrence rate of medical treatment restricted the treatment efficacy. High intensity focused ultrasound received a great attention in the field of treatment of uterus due to its non-invasive and preservation of uterus characteristic.With the devolopment of the technique of high intensity focused ultrasound, we found that it took longer time and lager irradiation energy to ablate uterine fibroids with hyperintensity on MR T2WI, and the non-perfused volume(NPV) ratio is much lower than that of fibroids with low MR T2WI signal. How to change the acoustic environment of uterine fibroids with high MR T2WI signal to increase the NPV ratio and decrease its exposure time? This study tested the method of conducting percutaneous ethanol injection(PEI) before HIFU, compares HIFU+PEI ablation and HIFU ablation only, to compare the advantages and disadvantages of each method are listed and discussed how to improve the tumour ablation rate of uterine fibroids with MR T2 WI high signal.Objective:The purpose of this paper was to discusses the safety and effectiveness of high intensity focused ultrasound (HIFU) combined percutaneous ethanol injection (PEI) to ablate uterine fibroids with high MR T2WI signal.Materials and methods:From Octobor,2011 to march,2015 in the second affiliated hospital of chongqing medical university,55 patients with solitary uterine fibroids with high MR T2WI signal were enrolled in this study. Among them,25 cases were treated with HIFU combined PEI(the experimental group), the rest 30 cases were treated with HIFU ablation(the control group). Comparisons of preoperative fibroid volume, exposure time, average exposure power, exposure energy, ablation rate, energy efficiency factor, intraoperative pain score, intraoperative ultrasound grayscale change and incidence of postoperative adverse reactions are made between the two groups.Result:1)For the experimental group, the exposure time was 809.72±523.41s, average exposure power was 309.04±60.30W, exposure energy was 256.27±169.21kJ. All these parameters were much lower than the control group, whoes exposure time was 1181.30±413.12s, average exposure power was 359.33±21.88W exposure energy was 425.28±151.60kJ, (P<0.05). The hysteromyoma ablation rate of the experimental group and control group were 86.41±5.21% and 74.07±8.54% respectively, with a great statistical credibility (P< 0.01).2)Crumby grayscale changes occur in 22 cases among the experimental group (88.0%), the time takes for intraoperative crumby grayscale changes appear was 203.59±142.11s. Crumby grayscale changes occur in 23 cases among the control group (76.7%), the time takes for intraoperative crumby grayscale changes appear was 359.00±124.37s. The data of the time takes for intraoperative crumby grayscale changes appear was statistically significant (P< 0.01).3)The median of intraoperative pain score for the experimental group was 2 points (range:0～4 points). While,The median of intraoperative pain score for the control group was 3 points (range:1～5 minutes), P< 0.01, the difference was statistically significant.4)According to the postoperative and follow-up records, complications of all the research samples were SIR class A-B, persistent period of all adverse reactions were not more than 1 week. The patients generally did not need special treatment or just simple drug treatment could return to normal, and there were no SIR class C-F complications occurred. The most common postoperative complications were the pain(lower abdominal pain treatment area and sacral tail pain) and abnormal vaginal discharge, For the experimental group there were 9 cases (36.00%) patients with postoperative pain,4 cases (16.00%) patients with abnormal vaginal discharge. And for the control group, there were 19 cases (63.33%) with postoperative pain and 5 cases (16.67%) with abnormal vaginal discharge. There was no statistically significant difference between two groups (P>0.05).Conclusion:Based on our results, percutaneous ethanol injection(PEI) combined with HIFU for uterine fibroids with high MR T2WI signal was safe and effective, and it seemed that HIFU combine with PEI could improve the treatment efficacy and reduce the intraoperative adverse reactions of HIFU for uterine fibroids. |
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