| Background:Uterine fibroids is one of the most common benign tumor, Whose incidence is as high as 30%-40%,and pathogenesis is not yet clear.The treatment of uterine fibroids is a lot,such as tradition opens abdomen operation, laparoscope,hysteroscopy and Uterine Artery Embolization(UAE).But these treatment are all invasive therapy,and they have both advantages and disadvantages.As a new noninvasive treatment technology,High Intensity Focused Ultrasound(HIFU) begins to play a more and more important role in the treatment of uterine fibroids.there is a lot of clinical study enhancing ablation effects of uterine fibroids with HIFU.Multiple basic studies have found that microbubble contrast agent can enhance ablation effects of HIFU,but clinical study of enhancing ablation effects of uterine fibroids with HIFU by microbubble contrast agent is still in its early phase.Objective:To investigate synergistic effect,safety and opportunity of microbubble contrast agent in HIFU ablation of uterine fibroids.Methods:94 patients from Suining Central Hospital who were confirmed Single uterine fibroids during 2012.3-2014.7 were selected,and the were treated with the HIFU tumor treatment system(JC200) developed by Chongqing Haifu Technology Co.,LTD.Patients were randomly divided into obsever group(60 patients) and control group (34 patients),the control group marked as group C, group C not recieved intravenous injection of microbubble contrast agent. Obsever group were randomly divided into group A and group B,group A recieved intravenous injection of microbubble contrast agent before HIFU therapy,and they began to recieve HIFU therapy after recieving intravenous injection of microbubble contrast agent 3 minute.Group B recieved intravenous injection of microbubble contrast agent before HIFU therapy too,and they began to recieve HIFU therapy after recieving intravenous injection of microbubble contrast agent 8 minute.With the methods of pairwise comparison,Rank sun test was used for statistical comparisons of median sonication power,total sonication time, intensity of treatment, treatment dosage,sonication time to achieve massive gray-scale changes and fractional ablation.The χ2 test was used for statistical comparisons of location of fibroids,magnetic resonance signal of fibroids,rate of massive gray scale changes and the incidence rate of adverse reactions in the treatment.Results:(1) The general condition of patients and fibroids in group A,group B and group C was compared,the age of patients,location of fibroids,magnetic resonance signal of fibroids and volume of fibroids all had no statistical difference.(2) Group A:There were 26 patients of 30 cases(86.7%) having massive gray scale changes, Sonication time to achieve massive gray scale changes was 26(14-267)s,median intensity of treatment was 576 (516-639)s/h,median treatment dosage was 232800(91350-402700)J, median fractional ablation was 91.25(85.40-102.19)%.(3) Group B:There were 18 patients of 30 cases(60.0%) having massive gray scale changes,Sonication time to achieve massive gray scale changes was 99(24-188)s,median intensity of treatment was 654(539-737)s/h,median treatment dosage was 320600(207775-511700)J, median fractional ablation was 95.93(80.50-99.79)%.(4) Group C:There were 12 patients of 34cases(40.0%) having massive gray scale changes,Sonication time to achieve massive gray scale changes was 828(216-1044)s,median intensity of treatment was 729(638-792)s/h,median treatment dosage was 340000(179479-557525)J, median fractional ablation was 84.06(69.86-92.10)%.(5) Comparing group A and group B,the P value of intensity of treatment, treatment dosage and rate of massive gray scale changes were 0.028,0.048 and 0.039, and the difference were statistically significant. These date indicated that the enhancing ablation effects of microbubble contrast agent to group A was better than that to group B.(6) Comparing group A and group C,the P value of intensity of treatment, treatment dosage, rate of massive gray scale changes, sonication time to achieve massive gray-scale changes and fractional ablation were 0.000,0.046,0.000,0.000 and 0.002, and the difference were statistically significant. In conclusion,Microbubble contrast agent can obviously increase achieve clinical enhancing ablation effects.(7) Comparing group B and group C,the P value of intensity of treatment, rate of massive gray scale changes, sonication time to achieve massive gray-scale changes and fractional ablation were 0.038,0.048, 0.012 and 0.006, and the difference were statistically significant. In conclusion,microbubble contrast agent can obviously enhance ablation effects of uterine fibroids with HIFU.(8) In the whole course of treatment,in group A,6 patients(20.0%) did complain of intra-procedure leg pain,15 patients (50.0%)did complain of sciatic or buttock pain,23 patients (76.7%)did complain of discomfort on skin and 21 patients(70.0%) did complain of lower abdominal pain.In group B,5 patients(16.7%) did complain of intra-procedure leg pain,21 patients(70.0%) did complain of sciatic or buttock pain,21 patients(66.7%) did complain of discomfort on skin and 20 patients (66.7%)did complain of lower abdominal pain.In group C,5 patients(14.7%) did complain of intra-procedure leg pain,22 patients(64.7%) did complain of sciatic or buttock pain,22 patients(64.7%) did complain of discomfort on skin and 23 patients(67.6%) did complain of lower abdominal pain. With the methods of pairwise comparison,P>0.05,the difference was not statistically significant. So HIFU ablation of uterine fibroids with microbubble contrast agent is feasible and safe, without major adverse events.Conclusions:HIFU ablation of uterine fibroids with microbubble contrast agent is effective and safe,and the synergy opportunity was closely ralated to the interval time between recieving intravenous injection of microbubble contrast agent and starting to recieve HIFU therapy.After concentration of microbubble contrast agent peaked,the shorter the interval time,the better the enhancing ablation effects.The best synergy opportunity will to be further studied. |
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