子宫腺肌病高强度聚焦超声消融治疗研究进展

doi:10.6040/j.issn.1671-7554.0.2022.0225

摘要/Abstract

摘要： 子宫腺肌病是女性常见的慢性疾病,近年来,其发病率呈上升趋势,且逐渐年轻化,而传统治疗方法难度大、风险高、并发症多、恢复慢。对于年轻有生育要求或者坚决要求保留子宫的患者而言,如何缓解症状、减少复发,缩短等待妊娠时间、改善子宫内膜容受性成为目前迫切需要解决的问题。高强度聚焦超声是一种新型的无创治疗方法,临床已证实其安全性和有效性,可作为子宫腺肌病综合治疗阶梯式管理的有效步骤。

关键词: 子宫腺肌病, 高强度聚焦超声消融, 妊娠

Abstract: Adenomyosis is a common chronic disease among women of reproductive age. In recent years, the prevalence rate has increased along with symptoms arising at a younger age. Traditional treatments are difficult to maneuver, followed with many complications and an extensive recovery time. Problems as how to relieve symptoms, reduce recurrence rate, shorten the wait time required for pregnancy, and restore endometrial receptivity have become urgent, especially for young women suffering from infertility. High intensity focused ultrasound(HIFU)is a novel non-invasive treatment method, whose safety and efficacy have been proved in clinical practice; it can be used as an effective step in the comprehensive treatment of adenomyosis

Key words: Adenomyosis, High intensity focused ultrasound, Pregnancy

中图分类号:

R711.74

艾星子·艾里,郭铮宇,张晓霏. 子宫腺肌病高强度聚焦超声消融治疗研究进展[J]. 山东大学学报 (医学版), 2022, 60(7): 36-42.

AILI Aixingzi, GUO Zhengyu, ZHANG Xiaofei. Latest research advances of high intensity focused ultrasound treatment for adenomyosis[J]. Journal of Shandong University (Health Sciences), 2022, 60(7): 36-42.

参考文献

[1] Ishika P, Feng W, David C. Oxfords clinical experience in the development of high intensity focused ultrasound therapy [J]. Int J Hyperthermia, 2021, 38(2): 81-88.
[2] 王智彪, 郎景和. 高强度聚焦超声消融与子宫腺肌病[J]. 中华妇产科杂志, 2016, 51(9): 708-709.
[3] Lynn J, Zwemer R, Chick A, et al. A new method for the generation and use of focused ultrasound in experimental biology [J]. J Gen Physiol, 1942, 26(2): 179-193.
[4] Fry W, Barnard J, Fry F, et al. Ultrasonically produced localized selective lesions in the central nervous system [J]. Am J Phys Med, 1955, 4(3): 413-423.
[5] Bachu V, Kedda J, Suk I, et al. High-intensity focused ultrasound: a review of mechanisms and clinical applications [J]. Ann Biomed Eng, 2021, 49(9): 1975-1991.
[6] 王智彪, 伍烽, 王芷龙, 等. 高强度聚焦超声对香猪肝组织定位损伤的研究[J]. 中国超声医学杂志, 1997, 13(2): 1-3. WANG Zhibiao, WU Feng, WANG Zhilong, et al. The oriented injury effects of high intensity focused ultrasound upon miniswine live tissues [J]. Chinese Journal of Ultrasound in Medicine, 1997, 13(2): 1-3.
[7] Chen W, Zhu H, Zhang L, et al. Primary bone malignancy: effective treatment with high-intensity focused ultrasound ablation [J]. Radiology, 2010, 255(3): 967-978.
[8] 汪伟, 刘文英, 周洁敏,等. 高强度聚焦超声治疗症状性子宫肌瘤的初步临床研究[J]. 中华超声影像学杂志, 2002, 11(3): 32-34. WANG Wei, LIU Wenying, ZHOU Jiemin, et al. Treatment of symptomatic uterine leiomyomata with high intensity focused ultrasound: a preliminary clinical study [J]. Chinese Journal of Ultrasonography, 2002, 11(3): 32-34.
[9] 杜成超, 周洪贵. 核磁共振成像在高强度聚焦超声治疗子宫腺肌病中的价值[J]. 中国计划生育和妇产科, 2018, 10(4): 30-34.
[10] Peng S, Xiong Y, Li K, et al. Clinical utility of a microbubble-enhancing contrast(“SonoVue”)in treatment of uterine fibroids with high intensity focused ultrasound: A retrospective study [J]. Eur J Radiol, 2012, 81(12): 3832-3838.
[11] Zhao W, Chen J, Zhang L, et al. Feasibility of ultrasound-guided high intensity focused ultrasound ablating uterine fibroids with hyperintense on T2-weighted MR imaging [J]. Eur J Radiol, 2013, 82(1): e43-e49.
[12] Zhou M, Chen J, Tang L, et al. Ultrasound-guided high-intensity focused ultrasound ablation for adenomyosis: the clinical experience of a single center [J]. Fertil Steril, 2011, 95(3): 900-905.
[13] Qin J, Chen J, Zhao W, et al. Outcome of unintended pregnancy after ultrasound-guided high-intensity focused ultrasound ablation of uterine fibroids [J]. Int J Gynaecol Obstet, 2012, 117(3): 273-277.
[14] Wang W, Wang Y, Wang T, et al. Safety and efficacy of US-guided high-intensity focused ultrasound for treatment of submucosal fibroids [J]. Eur Radiol, 2012, 22(11): 2553-2558.
[15] Wang F, Tang L, Wang L, et al. Ultrasound-guided high-intensity focused ultrasound vs laparoscopic myomectomy for symptomatic uterine myomas [J]. J Minim Invasive Gynecol, 2014, 21(2): 279-284.
[16] Wu F, Wang Z, Chen W, et al. Extracorporeal high intensity focused ultrasound ablation in the treatment of 1038 patients with solid carcinomas in China: an overview [J]. Ultrason Sonochem, 2004, 11(3-4): 149-154.
[17] 曹正珺, 艾星子·艾里. 高强度聚焦超声治疗子宫腺肌症的现状[J]. 医学综述, 2016, 22(17): 3406-3409. CAO Zhengjun, AILI Aixingzi, Status of high intensity focused ultrasound treatment of adenomyosis [J]. Medical Recapitulate, 2016, 22(17): 3406-3409.
[18] Wu F, Chen W, Bai J, et al. Tumor vessel destruction resulting from high-intensity focused ultrasound in patients with solid malignancies [J]. Ultrasound Med Biol, 2002, 28(4): 535-542.
[19] 聚焦超声消融手术临床应用技术规范专家共识(2020年版)[J]. 中华医学杂志, 2020, 100(13): 974-977.
[20] 郑婵, 张炼. 高强度聚焦超声治疗子宫腺肌病的临床应用进展[J]. 现代医药卫生, 2016, 32(14): 2160-2162.
[21] 邓勇斌. 手术切除与超声消融治疗子宫腺肌病多中心同期临床对照研究[J]. 实用妇科内分泌杂志(电子版), 2017, 29(4): 92-93.
[22] Jeng C, Ou K, Long C, et al. 500 Cases of high-intensity focused ultrasound(HIFU)ablated uterine fibroids and adenomyosis [J]. Taiwan J Obstet Gynecol, 2020, 59(6): 865-871.
[23] 冯玉洁, 陈锦云, 胡亮, 等. HIFU消融治疗弥漫型和局限型子宫腺肌病的近远期疗效[J]. 中国介入影像与治疗学, 2017, 14(1): 22-26. FENG Yujie, CHEN Jinyun, HU Liang, et al. Short-term and long-term efficacy of HIFU ablation for diffuse and focal adenomyosis [J]. Chin J Interv Imaging Ther, 2017, 14(1): 22-26.
[24] Zhang L, Rao F, Setzen R. High intensity focused ultrasound for the treatment of adenomyosis: selection criteria, efficacy, safety and fertility [J]. Acta Obstet Gynecol Scand, 2017, 96(6): 707-714.
[25] Gong C, Setzen R, Liu Z, et al. High intensity focused ultrasound treatment of adenomyosis: the relationship between the features of magnetic resonance imaging on T2 weighted images and the therapeutic efficacy [J]. Eur J Radiol, 2017, 89: 117-122.
[26] 刘畅, 陈锦云, 陈文直, 等. MR T₂WI信号特征预测HIFU消融治疗子宫腺肌病疗效[J]. 中国介入影像与治疗学, 2018, 15(6): 345-350. LIU Chang, CHEN Jinyun, CHEN Wenzhi, et al. Signal characteristics of MR T₂WI in prediction of HIFU treatment outcome for adenomyosis [J]. Chin J Interv Imaging Ther, 2018, 15(6): 345-350.
[27] Liu X, Wang W, Wang Y, et al. Clinical predictors of long-term success in ultrasound-guided high-intensity focused ultrasound ablation treatment for adenomyosis: a retrospective study [J]. Medicine(Baltimore), 2016, 95(3): e2443.
[28] 徐锋, 镡丽霞, 李盼, 等. 高强度聚焦超声消融联合GnRHa治疗子宫腺肌病的临床研究[J]. 国际妇产科学杂志, 2019, 46(6): 618-620. XU Feng, TAN Lixia, LI Pan, et al. Clinical study of high-intensity focused ultrasound ablation combined with GnRHa in the treatment of adenomyosis [J]. J Int Obstet Gynecol, 2019, 46(6): 618-620.
[29] Pang L, Mei J, Fan L, et al. Efficacy of high-intensity focused ultrasound combined with GnRH-a for adenomyosis: a systematic review and meta-analysis [J]. Front Public Health, 2021, 9: 688264. doi:10.3389/fpubh.2021.688264.
[30] Guo Q, Xu F, Ding Z, et al. High intensity focused ultrasound treatment of adenomyosis: a comparative study [J]. Int J Hyperthermia, 2018, 35(1): 505-509.
[31] Yang X, Zhang X, Lin B, et al. Combined therapeutic effects of HIFU, GnRH-a and LNG-IUS for the treatment of severe adenomyosis [J]. Int J Hyperthermia, 2019, 36(1): 485-491.
[32] 王小兰, 赵洪, 陈行. 高强度聚焦超声联合GnRH-a对子宫腺肌症患者血清CA125、PGF2a、脂联素的影响[J]. 中国计划生育学杂志, 2021, 29(2): 246-250. WANG Xiaolan, ZHAO Hong, CHEN Xing. Effects of high intensity focused ultrasound combined with gnrrho-a on serum CA125, PGF2a and adiponectin levels of patients with adenomyosis [J]. Chin J Fam Plann, 2021, 29(2): 246-250.
[33] 蒋静, 周洪贵, 陈燕, 等. 高强度聚焦超声联合促性腺激素释放激素激动剂治疗子宫腺肌症的前瞻性研究[J]. 重庆医学, 2019, 48(10): 1705-1708. JIANG Jing, ZHOU Honggui, CHEN Yan, et al. Prospective study of high intensity focused ultrasound combined with gonadotropin releasing hormone agonist in treating adenomyosis [J]. Chongqing Medicine, 2019, 48(10): 1705-1708.
[34] Zhang X, Guo Y, Chen J, et al. Effect of pre-treatment with gonadotropin-releasing hormone analogue GnRH-α on high-intensity focused ultrasound ablation for diffuse adenomyosis: a preliminary study [J]. Int J Hyperthermia, 2018, 34(8): 1289-1297.
[35] 张格. 子宫腺肌病超声消融治疗后痛经疗效与复发的研究[D]. 石家庄:河北医科大学, 2020.
[36] 时玲玲, 杨秀梅, 朱丽华. 高强度聚焦超声联合米非司酮治疗子宫腺肌症效果研究[J]. 解放军医药杂志, 2017, 29(9): 17-21. SHI Lingling, YANG Xiumei,ZHU Lihua. Effect of Noninvasive High Intensity Focused Ultrasound Combined with Mifepristone in Treatment of Patients with Adenomyosis [J]. Medical & Pharmaceutical Journal of Chinese Peoples Liberation Army, 2017, 29(9): 17-21.
[37] 谢元媚. 高强度聚焦超声消融应用于子宫腺肌病合并子宫肌瘤治疗中的近期疗效与安全性观察[J]. 系统医学, 2019, 4(2): 96-98. XIE Yuanmei. Short-term Efficacy and Safety of High-intensity Focused Ultrasound Ablation in the Treatment of Adenomyosis with Uterine Fibroids [J]. Systems Medicine, 2019, 4(2): 96-98.
[38] 李远明, 刘君, 苏园园, 等. 高强度聚焦超声消融治疗对子宫内膜容受性的影响[J]. 中国医学创新, 2017, 13(14): 40-43. LI Yuanming, LIU Jun, SU Yuanyuan, et al. Study on the effects of high intensity focused ultrasound therapy on the endometrial receptivity [J]. Medical Innovation of China, 2017, 13(14): 40-43.
[39] Ferrari F, Arrigoni F, Miccoli A, et al. Effectiveness of magnetic resonance-guided focused ultrasound surgery(MRgFUS)in the uterine adenomyosis treatment: technical approach and MRI evaluation [J]. Radiol Med, 2016, 121(2): 153-161.
[40] 范宏杰, 彭清, 寸江平, 等. 高强度聚焦超声消融局限型子宫腺肌症[J]. 中国介入影像与治疗学, 2018, 15(9): 540-543. FAN Hongjie, PENG Qing, CUN Jiangping, et al. High intensity focused ultrasound ablation of focal adenomyosis [J]. Chinese Journal of Interventioual Imaging and Therapy, 2018, 15(9): 540-543.
[41] Vercellini P, Consonni D, Dridi D, et al. Uterine adenomyosis and in vitro fertilization outcome: a systematic review and meta-analysis [J]. Hum Reprod, 2014, 29(5): 964-977.
[42] 王智, 邹敏, 陈骊, 等. 子宫腺肌病患者高强度聚焦超声治疗后妊娠结局的观察[J]. 重庆医学, 2017, 46(18): 2506-2508. WANG Zhi, ZOU Min, CHEN Li, et al. Observation on pregnancy outcomes after high intensity focused ultrasound ablation therapy in patients with adenomyosis [J]. Chongqing Medicine, 2017, 46(18): 2506-2508.
[43] 周春艳, 徐小娟, 何佳. 高强度聚焦超声消融技术治疗子宫腺肌病的疗效及妊娠结局的观察[J]. 中华妇产科杂志, 2016, 51(11): 845-849. ZHOU Chunyan, XU Xiaojuan, HE Jia. Pregnancy outcomes and symptom improvement of patients with adenomyosis treated with high intensity focused ultrasound ablation [J]. Chinese Journal of Obstetrics and Gynecology, 2016, 51(11): 845-849.
[44] Chen J, Chen W, Zhang L, et al. Safety of ultrasound-guided ultrasound ablation for uterine fibroids and adenomyosis: a review of 9988 cases [J]. Ultrason Sonochem, 2015, 27: 671-676. doi:10.1016/j.ultsonch.2015.05.031.
[45] 束长珍. 93例HIFU治疗子宫肌瘤的不良反应及近期并发症的临床观察[D]. 苏州:苏州大学, 2017.
[46] Lee J, Hong G, Lee K, et al. Safety and efficacy of ultrasound-guided high-intensity focused ultrasound treatment for uterine fibroids and adenomyosis [J]. Ultrasound Med Biol, 2019, 45(12): 3214-3221.
[47] 何玉春, 罗爽, 黄国华, 等. 聚焦超声消融治疗子宫良性疾病不良反应分析[J]. 中国实用妇科与产科杂志, 2020, 36(3): 272-275. HE Yuchun, LUO Shuang, HUANG Guohua, et al. Adverse effect analysis of focused ultrasound ablation in the treatment of benign uterine diseases [J]. Chinese Journal of Practical Gynecology and Obstetrics, 2020, 36(3): 272-275.
[48] 周凯, 申凤珠, 左玲. 高强度聚焦超声治疗子宫(腺)肌瘤血尿原因分析[J]. 临床超声医学杂志, 2010, 12(7): 495-496.
[49] Liu Y, Zhang W, He M, et al. Adverse effect analysis of high intensity focused ultrasound in the treatment of benign uterine diseases [J]. Int J Hyperth, 2018, 35(1), 56-61.

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