间层辐照消融模式与逐层辐照消融模式在HIFU治疗子宫肌瘤中的有效性对比：一项回顾性研究

Comparison of the Effectiveness of Inter-Slice Sonication Ablation Pattern and Slice-by-Slice Sonication Pattern in HIFU Treatment of Uterine Fibroids: A Retrospective Comparative Study

摘要: 目的：对比间层辐照消融模式与逐层辐照消融模式在高强度聚焦超声(HIFU)治疗子宫肌瘤中的有效性及安全性，探讨新模式的临床应用价值。方法：采用回顾性队列研究，纳入2019年1月至2024年5月227例单发子宫肌瘤患者(最大直径2.5~10 cm)，按治疗方式分为间层辐照组(n = 73)和逐层辐照组(n = 154)。逐层辐照组采用“点–面–体”逐层消融，间层辐照组仅选取三个等分切面消融。主要评价指标为术后MRI评估的消融率(非灌注体积比)及能效因子(EEF)；次要指标包括治疗时间、平均功率及术后短期并发症(疼痛、皮肤水肿等)。采用非参数秩和检验、卡方检验进行统计分析，并基于肌瘤位置(前壁/后壁)进行亚组分析。结果：间层辐照消融组的消融率(76.38% ± 1.67%)显著高于逐层辐照消融组(73.06% ± 0.82%, P = 0.007)，且治疗时间显著缩短(388.84 ± 23.61 s vs. 544.83 ± 24.78 s, P = 0.002)；但两组间平均功率(333.73 ± 51.54 W vs. 336.79 ± 41.21 W, P = 0.824)及能效因子(EEF: 5.28 ± 0.95 vs. 3.99 ± 0.32, P = 0.275)无统计学差异。安全性方面，两组术后短期并发症(疼痛、皮肤水肿、阴道溢液及神经症状)发生率均无统计学差异(P > 0.05)，且所有并发症严重程度均为CTCAE 1~2级。结论：间层辐照消融模式在保证安全性的前提下，显著缩短HIFU治疗时间并提高消融效率。其机制可能与声能量重分布及“损伤–损伤”效应增强有关，为优化子宫肌瘤HIFU治疗提供了新方向。

Abstract: Objective: To compare the efficacy and safety of the Inter-Slice Sonication Ablation Pattern versus the Slice-by-Slice Sonication Ablation Pattern in High-Intensity Focused Ultrasound (HIFU) treatment of uterine fibroids, assessing the clinical value of the novel pattern. Methods: This retrospective cohort study enrolled 227 patients with solitary uterine fibroids (maximum diameter 2.5~10 cm) treated between January 2019 and May 2024. Patients were divided into the Inter-Slice Sonication group (n = 73) and the Slice-by-Slice Sonication group (n = 154). The Slice-by-Slice Sonication group received standard “point-by-point” layered ablation; the Inter-Slice Sonication group underwent ablation targeting only three equally spaced planes within the fibroid. Primary outcomes were ablation ratio (non-perfused volume ratio assessed by postoperative MRI) and Energy Efficiency Factor (EEF). Secondary outcomes included treatment time, average power, and short-term postoperative complications (pain, skin edema, etc.). Statistical analysis employed the Mann-Whitney U test and Chi-square test, and subgroup analysis was conducted based on the location of the fibroid (anterior wall/posterior wall). Results: The Inter-Slice Sonication group demonstrated a significantly higher ablation ratio (76.38% ± 1.67%) compared to the Slice-by-Slice Sonication group (73.06% ± 0.82%; P = 0.007) and significantly shorter treatment time (388.84 ± 23.61 s vs. 544.83 ± 24.78 s; P = 0.002). No significant differences existed in average power (333.73 ± 51.54 W vs. 336.79 ± 41.21 W; P = 0.824) or EEF (5.28 ± 0.95 vs. 3.99 ± 0.32; P = 0.275). Both groups exhibited comparable incidence rates of short-term postoperative complications (pain, skin edema, vaginal discharge, neurological symptoms; all P > 0.05). All complications were mild (CTCAE grade 1~2). Conclusion: The Inter-Slice Sonication Ablation Pattern significantly reduces HIFU treatment time and improves ablation efficiency while maintaining safety. This efficacy may arise from enhanced ultrasound energy redistribution and “damage-damage” interference effects, offering a promising new approach for optimizing HIFU fibroid treatment.