| Objective: To compare the therapeutic effects of high-intensity focused ultrasound on the uterine fibroids with different T2W1 signals,and to explore the factors affecting the efficacy of high-intensity focused ultrasound in ablation of uterine fibroids in MRI signals.Methods : This study selected 156 patients with uterine fibroids(a total of 210 uterine fibroids)who were treated for the first time in the HIFU Center of the First People's Hospital of Neijiang from June 2015 to June 2016,according to preoperative magnetic resonance imaging.The different signal performance of T2W1 on MRI is divided into low signal group,equal signal group,high signal group and mixed signal group.The general situation,fibroid location,fibroid properties,fibroid volume and therapeutic dose parameters,efficacy and safety of the four groups of patients were compared.Results: 1.The general condition of the patient included age,BMI,abdominal thickness and the distance between the deep surface of the tumor and the tail of the tumor(P>0.05).The difference was not statistically significant.The comparison between the position of fibroids and the nature of fibroids in each group,There was also no significant difference(P>0.05).2.Fibroid volume and the treatment parameters in patients with four groups of comparison,There were no significant differences in the average power and treatment intensity between the four groups of patients(P>0.05).The difference in fibroid volume,irradiation time and treatment dose was statistically significant(P > 0.05);the low signal group fibroid volume was smaller than the high signal group and mixed signal groups(P<0.05),no significant difference between other groups(P>0.05);the irradiation time of the high signal group was longer than that of the low signal group and the mixed signal group(P<0.05).no significant difference between other groups(P>0.05);The high-signal group treatment dose was significantly higher than the other three groups of fibroids(P<0.05).no significant difference between other groups(P>0.05);3.The immediate ablation rate(%)of the four groups of fibroids was: 77.85±13.87.The immediate ablation rate(%)of the low signal group,the equal signal group,the high signal group and the mixed signal group were: 78.67±14.52,82.62±12.34,71.18±12.33,80.18±12.14;The overall energy efficiency factor(J/mm3)of the four groups of fibroids was: 6.75±8.72,and the energy efficiency factors(J/mm3)of each group were 6.63±8.18?3.89±2.35?10.49±13.19,and 4.56±4.29,respectively.The differences were statistically significant(P<0.05).There were significant differences between the high-signal group and the other three groups(P<0.05).The high-signal group had the lowest immediate ablation rate and the highest energy-efficiency factor;The rate of fibroid reduction between the four groups of fibroids were significant differences in the third and sixth months after surgery(P< 0.05).After 3 months of operation,a total of 149 patients(202 total fibroids)were followed up.The overall fibroid reduction rate(%)was: 37.83±17.73.The low signal group,the equal signal group,the high signal group and the mixed signal group were reviewed for fibroids.The reduction ratios(%)were: 38.65±13.66,38.06±17.77,29.00±19.61,and 43.95±23.16.After further comparison between groups,the reduction rate of fibroids in the high signal group was significantly lower than that in the low signal group and the mixed signal group.Six months after operation,a total of 144 patients(192 total fibroids)were followed up.The overall fibroid reduction rate(%)was 54.35±23.63.The rate of reduction of fibroids in each group was 58.52±18.58,61.10±22.38,38.07±22.81,55.53±31.48,when the two groups were compared,the reduction rate of fibroids in the high signal group was significantly lower than that in the low signal group,the equal signal group and the mixed signal group;At 12 months after follow-up,there were 65 patients in the low-signal group,9 in the signal group,30 in the high-signal group,and 29 in the mixed-signal group.The pregnancy rates of the four groups were 7.69%,0%,3.33%,and 3.45%,respectively.The reintervention rates of fibroids were 9.23%,0%,16.67%,and 10.34%,respectively,and the high-signal group had the highest reintervention rate.4.All patients had stable vital signs and no serious adverse reactions during the operation.The SIR classification was safe treatment.There was no significant difference in the incidence of adverse reactions such as radiation pain,sacrococcygeal pain,skin scald,pain in the treatment area,inguinal pain and hip fold pain,and the incidence of adverse reactions such as lower abdominal pain and sacrococcygeal pain after operation between the four groups(P > 0.05).There were no patients with fever and lower limb sensorimotor abnormality after operation;two patients in the low-signal group and the mixed signal group had vaginal discharge after operation,mainly showing a little vaginal bleeding,which improved after two weeks of close follow-up.Conclusion: High-intensity focused ultrasound can safely and effectively ablate different T2W1 signaling fibroids.However,relatively low signal,equal signal and mixed signal fibroids,high signal fibroids are more difficult in the treatment process,requiring more therapeutic doses,longer irradiation time;the treatment effect is also relatively worse,high signal fibroids The lowest energy efficiency factor,immediate ablation rate,three months after surgery and six months after surgery,the rate of fibroid reduction was relatively low,and the reintervention rate was the highest in the 12 months after surgery. |
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