子宫腺肌症治疗.ppt

Click to edit Master title style,Click to edit Master text styles,Second level,Third level,Fourth level,Fifth level,*,湖北省妇幼保健院,Maternity and child care centers in hubei province,Wang Yan,project date,20/09/2007,高强度聚焦超声治疗子宫腺肌症的临床研究,The Clinical Study Of Ultrasound-guided High-intensity Focused Ultrasound,Ablation For Adenomyosis,概念,onception,02,子宫腺肌病,(adenomyosis,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 influence on the quality of life of patients are getting more and more serious,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,、,childbirth,etc-which usually damage the,endometrium and shallow myometrium,caused the basal layer of endometrium invade into myometrium,根治性手术,R,adical surgery,子宫+双附件切除术,Hysterectomy and bilateral salpingo-oophorectomy(BSO),手术治疗,surgical treatment,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 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：1%,R,adical surgery,保守性手术：80-95%,Conservative operation,治疗方式的选择,The choice of treatments,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,保留子宫,Preservation of the uterus,非侵入性 Non-invasive,不需麻醉No anesthesia,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,The ideal treatmants,High Intensity Focused Ultrasound Ablation by Haifus Model JC200,skin,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 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 seriously 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,Excluding criterion,Patient data：accompanying symptoms患者资料：伴随症状,Case,病例数,40,With symptoms（%）,出现症状率,100%,Lower abdominal swelling 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%,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,fentanyl.,治疗前、后超声造影,Receive contrast-enhanced ultrasound before and after treatment.,治疗方法,therapeutic method,治疗参数,Treatment parameter,Frequency频率：1MHz,Focal length焦距：134mm,Diameter of trasnducer 治疗头直径：220mm,Scanning mode扫描模式：single exposure点扫描,Thickness 层面距离：4-5mm,Starting power 开始功率：250w-300w,Maximal power,最大功率,：400w,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 quantitative 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,The evaluations of efficacy after,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,computie the effective in ablating by contrast-enhanced ultrasound,病例插图3,The,3th illustration of cases,腺肌瘤体积（FV）=,消融体积（NPV）=,体积消融比率=NPV/FV100%=,治疗前后各指标变化情况 The change of indexs before and after treatment,结果,results,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-enhanced 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 deactivation 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,The change after treatment,月经量增多改善 the,improvement of menstruation,临床症状改善,clinically improvement in symptoms,随访时间,follow-up time,显效obvious effects（%）,有效effective（%）,无效 invalid（%）,术后1月,after 1 month,3（7.5）,28（70）,9（22.5）,术后3月after3 month,8（20）,30（75）,2（5）,术后6月after 6 month,9（22.5）,29（72.5）,2（5）,HIFU,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 of high amplitude,some one appear strong echo.,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 enhanced 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,there are some smaller blood flow signals para-tumors.,影像学随访,follow-up of Imaging,HIFU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,perineum,legs,pain score was 2-3 points,all the patients could tolerance.),皮肤灼伤：未见,Skin Burns:no,HIFU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 adenomyosis which could reserved uterine and maintain women physiological functions.,小结,brief summary,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,Next Research Direction,谢谢,