MRI结合带厚度与子宫腺肌病高强度聚焦超声治疗效果的关系探讨

Exploration of the Relationship between the Thickness of MRI Binding Band and the Therapeutic Effect of High Intensity Focused Ultrasound in Adenomyosis

摘要: 目的：分析高强度聚焦超声(HIFU)治疗子宫腺肌病痛经改善情况与痛经评分的关系，同时分析MRI结合带厚度与子宫腺肌症HIFU治疗效果的关系。方法：选择2022年1月至2022年12月在宜宾市第二人民医院妇科就诊并经临床及影像学方法诊断为子宫腺肌病患者79例为研究对象。治疗前收集所有患者的痛经严重程度评分(VAS评分)以及结合带厚度，使用视觉模拟评分办法将腺肌病患者分为轻、中、重度三组，治疗后3月、6月、1年来院随访VAS评分，同时计算VAS变化值。MRI复查并计算消融率(NPV比值)，并把上述指标与病灶结合带厚度进行相关性分析。结果：(1) 79例患者均顺利完成HIFU治疗，治疗后轻度、中度、重度痛经组症状均得到显著缓解(P < 0.05)，且无严重并发症出现。(2) 轻度痛经组HIFU治疗效果明显好于中度及重度组(P < 0.05)；中度及重度组的HIFU治疗效果组间未见明显差异(P > 0.05)。(3) 轻度、中度、重度组在MRI结合带厚度与治疗后3月、6月、1年的VAS变化值、NPV比值均无显著相关性。结论：(1) HIFU治疗能明显改善子宫腺肌病患者的痛经症状；(2) 轻度痛经组HIFU治疗改善痛经评分明显好于中度及重度，为HIFU治疗子宫腺肌病的适应症优化提供一定依据。

Abstract: Objective: To analyze the relationship between dysmenorrhea improvement and dysmenorrhea score in the treatment of adenomyosis by high intensity focused ultrasound (HIFU). At the same time, to analyze the relationship between MRI band thickness and HIFU treatment effect in adenomyosis. Methods: From January 2022 to December 2022, 79 patients with adenomyosis diagnosed by clinical and imaging methods in the gynecology department of Yibin Second People’s Hospital were selected. Before treatment, the Visual Analogue Score (VAS) and the thickness of the conjunctival zone of all patients were collected. The patients were divided into three groups: mild, moderate and severe by VAS. The VAS scores were followed up 3 months, 6 months and 1 year after treatment. The VAS changes were calculated. The non-perfusion volume (NPV ratio) was calculated by MR. And the correlation between the above indexes and the thickness of the focal junction zone was analyzed. Results: (1) All 79 patients successfully completed HIFU treatment. The symptoms of all patients were significantly relieved after treatment (P < 0.05). No serious complications occurred. (2) The effect of HIFU in mild dysmenorrhea group was significantly better than that in moderate and severe groups (P < 0.05); There was no significant difference in HIFU treatment effect between moderate and severe groups (P > 0.05). (3) In mild, moderate and severe groups, there was no significant correlation between MRI junction thickness and VAS changes at 3 months, 6 months and 1 year after treatment, as well as NPV ratio. Conclusion: (1) HIFU treatment can significantly improve the symptoms of dysmenorrhea in patients with adenomyosis; (2) The VAS scores in mild group were significantly better than moderate and severe. And it provides a certain basis for optimizing the indication of HIFU in the treatment of adenomyosis.