| BackgroundUterine fibroids are the most common estrogen-dependent benign tumors of the female reproductive tract,accounting for 20 per cent of women of childbearing age 20~ 40%, the main symptoms of which include the increased menstrual extension of the basin sacral pain, sexual discomfort, bladder oppression and so on. In addition, uterine fibroid can cause infertility, habitual abortion and premature birth, and is the main reason for menorrhagia and abnormal uterine bleeding. Current clinical treatment methods are commonly used for surgical treatment, but since uterus has certain endocrine function, hysterectomy can cause early menopause, which brings great psychological burden to the patients, and consequently affect the quality of their lives, and meanwhile the patients can no longer reserve their reproductive capacity . Fibroid resection may retain the uterus, but the five-year recurrence rate is as high as 62%, and the re-operation rate is 9%. HIFU (high intensity focused ultrasound), a non-invasive cancer therapy targeting technology, has been launched extensively to ablate of solid tumors.Injury efficiency and sound environmental organizations are closely related to the target tissue of the blood supply richness, such as whether there has been adegeneration. Nutrient vessels plays an important role in leiomyoma growth,and insufficient blood perfusion may cause a variety of uterine leiomyoma degeneration, and therefore researches on their blood perfusion characteristics can help to understand the biological characteristics of fibroids. Since rich blood supply in the target area is not conducive to energy deposition in HIFU treatment process, to develop an effective method to reduce uterine fibroids perfusion appears to be particularly important.Quantitative color pixel technology has been maturely employed clinically. The hemodynamic parameters can reflect the peripheral artery disease resistance from different angles and provide information of the blood supply. This study employs color Doppler ultrasound to compare the difference of blood flow perfusion between the uterine fibroids and the healthy people, the difference of blood flow perfusion before and after the application of oxytocin, and the difference of blood flow perfusion before, after and one month after the HIFU treatment. From the blood supply status of uterine fibroids, CPA, the frequency chart shape of the nutrient vessels, and the hemodynamic parameters of the blood flow, this study evaluates the characteristics of the blood flow perfusion of uterine fibroids, the influences of oxytocin on the blood flow perfusion of uterine fibroids, and the early efficacy of HIFU treatment. Consequently, this study tries to determine the relationship among the application the richness of blood supply, dozes and effect so as to further direct HIFU treatment.ObjectiveThrough using color Doppler ultrasound, this study tries to evaluate the perfusion characteristics of uterine fibroids and to explore how uterine fibroids respond to the oxytocin, It compares the impacts of different doses of oxytocin on uterine fibroids perfusion, and explores the relationship between the blood supply, the dose application and the early efficacy of HIFU treatment on uterine It analyzes the perfusion characteristics of the fibroids that was treated ineffectively by using HIFU in early times and provides the basis for the selection of the patients before HIFU treatment and the formulation of the programme.Materials and methodsPart 1 Perfusion characteristics of uterine fibroids1.1 Subjects: 100 cases of uterine myoma and 50 cases of healthy volunteers were selected by the First Affiliated Hospital of Chongqing Medical University through the clinic and enhanced MRI confirmation.1.2 Devices: PHILIPS HD3 color Doppler ultrasonic machine and frequency of 3.5 MHz probe were used.1.3 Methods: Two-dimensional ultrasound clearly showed uterine fibroids, CDE showed the peripheral leiomyoma, the internal blood vessels, and arteries PW Acquisition spectrum And measured uterine fibroids trophoblast vascular diameter, and the corresponding detection of hemodynamic parameters (choose PSV, PI, RI to evaluate object). Color pixel quantitative measurement software was used to measure fibroids interested District CPA under the conditions of CDE. The ascending uterine artery diameter and the detection of hemodynamic parameters were measured under CDFI conditions. Results were analyzed by using the SAS8.0 statistics package.Part 2 The impact of oxytocin on uterine fibroids of blood perfusion2.1 Subject: School subjects, 60 patients with uterine fibroids confirmed through enhanced MRI, were selected by the First Affiliated Hospital through Subjects were divided evenly into Group A and B according to their attendance.2.2 Equipment: PHILIPS HD3 color Doppler ultrasonic machine and frequency of 3.5 MHz probe were used. 40 U of oxytocin (Shanghai Pharmaceutical Co., Ltd. abundance production) mixed with 500 ml of 5% glucose solution was applied.2.3 Methods: Before the application of oxytocin, uterine fibroids lesions were clearly shown on the two-dimensional ultrasound. CDE showed the surrounding cross-section of the fibroids and the internal blood vessels. CDFI showed the ascending artery and acquired the PW spectrum of the uterine artery. Group A were given about 0.04 U / min continuous static of oxytocin, Group B were given about 0.08 U / min continuous static point of oxytocin. Immediately after the administration, the fibroids peripheral and internal flow spectrum shape of Group A and B were observed through using the same methods. 30 minutes after the administration, a dynamic observation of the spectrum shape and the characteristic spectrum of plans was conducted and changes in the spectrum were recorded. At the end of the observation, the cross-sectional flow was intercepted to show the most abundant level of map, interest CPA area was measured. The surrounding trophoblast and uterine artery vascular hemodynamics of the uterine fibroids before and after the application of different doses of oxytocin were compared . Finally, a statistical analysis of the results was conducted by using the SAS8.0 statistics package .Part 3 The relationship between the early efficacy of HIFU treatment on uterine fibroids and the blood supply and the injected dose3.1 Subjects: the same subject with those of Part Two.3.2 Equipment: The intensity focused ultrasound equipment JC tumor therapeutic system (Chongqing Haifu (HIFU) Technology Co., Ltd. production), PHILIPS HD3 using color Doppler ultrasonic machine, and frequency of 3.5 MHz probe were used.3.3 Methods: Immediately before, after and one month after the HIFU operation, the Color Doppler Ultrasonography was used to clearly show the 2D ultrasound of the uterine fibroids and the volume of uterine fibroids. The peripheral vascular nourishment, uterine artery diameter and blood flow with the mechanical parameters were the same with those of the first part. Trough compareing the fibroids perfusion changes before, after and one monthafter the HIFU treatment, it compared the different efficacy of HIFU on uterine fibroids with different blood supply levels and energy inputs. It analyzed the corresponding perfusion characteristics of HIFU treatment of the poor cases. Finally, a statistical analysis of the results was conducted by using the SAS8.0 statistics package.Results1. Different types of fibroids have different characteristics of the blood flow distribution, and the CPA varies significantly in the fibroids of different types, different leiomyoma sizes or with different blood richness. Compared to the abundant blood supply with lower blood supply, the feeding vessels with richer blood supply have larger peripheral vascular diameter, higher PSV, PI and RI. Also, the vascular diameter, PSV, PI and RI of the peripheral nourishment vessels are larger and higher than those of internal. The uterine artery in uterine fibroid group appears to be diastolic high-frequent, low-resistance type, which means PSV and PI are increasing while RI is decreasing.2. Uterine fibroids have different responses when applied to different doses of oxytocin. Uterine fibroids of different types, locations and levels of the blood supply richness have different responses, which were manifested by the different waveform changes, to the application of oxytocin. The emergence of the abnormal waveform is conducive to monitor this change. The comparatively stronger continued contraction can lead to a significant decrease of the perfusion of the uterine fibroid, and the effect decreased when the fibroids of more rich blood supply(Ⅳlevel) were reduced the blood flow perfusion. The effect of oxytocin was more obvious when the fibroids were applied to larger dose of oxytocin. Oxytocin can cause a change in the hemodynamics of the fibroids'feeding vessels, and the larger dose of oxytocin can also cause the hemodynamic changes of the uterine artery. Therefore, it is safe and effective to reduce the perfusion in uterine fibroids by using oxytocin.3. HIFU treatment on uterine fibroids can result in the disappearance or an obvious decrease of perfusion. In a few cases, a little blood supply remained, and immediately after and one month after the operation, both the internal diameter of the peripheral nourishment vascular and PSV reduced, and PI and RI first increased and then decreased, but still higher than those before the ablation. One month after HIFU, PI of the uterine artery became high and RI became lower. Different doses of oxytocin should be treated on the fibroids with insufficient blood supply and rich blood supply. The effects varied when the fibroids were treated with different doses of oxytocin. In the early cases with the poor HIFU treatment effects in group A, the patients had extremely rich blood supply, they responded dissatisfied to the application of oxytocin. In group B, the patients had rich blood supply(Ⅱ～Ⅲlevel) . The PSV and diameter of internal and peripheral feeding vessels were high, and PI and RI were low.Conclusion1. Uterine fibroids perfusion has a certain characteristic. Vascular distribution, CPA, trophoblast vascular artery diameter, spectral and hemodynamic parameters can provide rich information on perfusion.2. Uterine fibroids have different responses to diffrent doses of oxytocin , and the emergence of different types of spectrum can help to detect this change, and the stronger continued contraction can lead to a significant decrease of the perfusion of the uterine fibroids.3. Using Doppler ultrasound in the detection of hemodynamic has obvious advantages. Through comparing the distribution of blood flow before and after HIFU treatment of uterine fibroids, Doppler ultrasound will be used for the evaluation of HIFU in the treatment of uterine fibroids, which has certain clinical value. The efficacy varies when different doses are injected. Finally researches examining the perfusion characteristics of the poor cases of HIFU treatment can provide reference for the patient's preoperative screening and the formulation of the programme.
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