| Purposes:1. To compare the varying echogram characteristics at each ablating periodand the relationship between conventional ultrasonography and contrast-enhancedultrasound (CEUS) under microwave ablation (MWA) for uterine muscle benign lesions,and investigate the feasibility and value of gray-scale ultrasound and CEUS inmonitoring the thermal field and evaluating the ablation effect in the ablating period ofMWA for uterine muscle benign lesions.2. To prospectively comparatively research thepreoperative, intraoperative and afteroperative recovery data of percutaneousmicrowave ablation and laparoscopic surgery in the treatment of uterine myomas, andfind out the basis of microwave ablation as the noninvasive, fast postoperativerecovering treatment.Methods:1. One hundred and ninety-four symptomatic uterine myomas oradenomyosis patients were recruited in this study (109cases of uterine myomas,62cases of adenomyosis). All of them received percutaneous microwave ablation treatmentand conventional ultrasound examination to observe the location, echo andcharacteristic of blood supply before ablation. During ablation use gray-scale ultrasoundto monitor the hyperechoic range of the ablation zone, after ablation do CEUS toobserve image characteristics and ablation range. Then compare the volume of thenon-enhanced zone immediately after ablation to the volume12-24hours after ablation. 2. Select26patients with uterine muscle benign lesions, measure the volume of thehyperechoic zone under gray-scale ultrasound, respectively compare that with thevolume of the non-enhanced zone12-24hours after ablation under CEUS and enhancedMRI.3. Measure the temperature of the6cases with11therm-measuring locuses.Needles were placed intramembrene or lateral0.3cm of the tumor pseudo-capsulerespectively. When the gray-scale ultrasound shows the hyperechoic reaches thethermometry needle location, instantly record the time and temperature. If thetemperature continues to rise, record the time needed to reach the60C and the highesttemperature during the whole treatment. Observe the relationship between thetherm-measuring spot and the hyperechoic position relation under gray-scale and theenhanced condition of CEUS immediately after microwave ablation.4. Select35patients of uterine myomas who received percutaneous microwave ablation,35patientswho received laparoscopic myomectomy surgery as contrast. Recorded and comparedthe differences between the two groups in the preoperative preparation, operative time,blood loss, postoperative body temperature, postoperative ambulation, diet recoverytime and the rate of postoperative1-year recurrence.Results:1. Before ablation, conventional sonography of uterine fibroids suggestedsphere or round-alike, homogeneous or inhomogeneous low echoes, coloring dopplerultrasound indicated ambitus ring-shape blood signals, while the performance ofadenomyosis was uterine muscle localized or diffuse thickening and the echo increasedand uneven. During the ablation, gray-scale echogram can clearly show the process ofmicrowave electrodes implanted in lesions and high echo from none to ens, from smallto large.2. Imaging manifestations of CEUS of uterine muscle benign lesions before and after ablation:(1) Before ablation, intramural uterine fibroids exhibited peripheralenhancement, with branched vessels extending from exterior to interior in the earlyphase. Submucous and subserous uterine fibroids displayed enhanced from basalnurturing vessels at early stage, gradually enhanced surrounding uterine fibroids andthen filled into central region. Adenomyosis lesions exhibited by fast enhancementmode, at the crest value the boundary of the lesion and the surrounding muscle was notclear.(2) Immediately after microwave ablation, the non-enhanced ablation areas werespherical or irregular shape with the rough edge. There was lineal and flakeenhancement in the ablation area.12to24hours after ablation, the ablation focus showsrelatively sharp boundary which is uniform non-enhanced area. The ablation volumeimmediately after ablation was smaller than the volume12-24hours after ablation, butthere was no statistical difference (t=1.138，P>0.05).3. The hyperechoic volumeimmediately after ablation was a little bigger than the non-enhancement area volume12-24hours after ablation, the difference was not statistical(t=1.097, P>0.05), butshowing a strong correlation (r=0.859，P <0.01); The comparison between hyperechoicvolume immediately after ablation and non-enhancement area of enhanced MRImeasurements after ablation has a good correlation(r=0.921，P<0.01), but there was nostatistical difference (t=0.996，P>0.05).4. When the hyperechoic edge reach theintended temperature location, the temperature is46C～47.7C（46.9±0.79） C.The highest temperatur（e64.4±6.7） C of all sites under the gray-scale ultrasound of thehyperechoic area were higher than the highest temperature（48.0±2.1） C of all sitesoutside the hyperechoic area, there was obvious difference (t=5.76，P<0.05), and allsites inside hyperechoic area under gray-scale ultrasound shows no enhancement by CEUS at immediately-after-ablation, but sites outside hyperechoic area still havecontrast agent perfusion. The time of hyperechoic immediately to the time when tissuetemperature to reach60C was37.5s-140s （75.8±55.9）s.5. The microwave ablationgroup is less than the laparoscopic group at the data of the operative time, intraoperativeblood loss, postoperative ambulation and diet recovery time and1year after relapserate.Conclusions:1. During the ablation period of percutaneous microwave ablation inuterine muscle benign lesions, the conventional ultrasonography and CEUS echogramvarying characteristic is brilliant, the clinical significance of each echogram is clear.CEUS12-24hours after microwave ablation can relatively accurately determine thepostoperative necrosis zone.2. Gray-scale ultrasound can real-time display the changesof the ablation zone echo, and the hyperechoic range on gray-scale image canprimitively represent the thermal field area.3. Microwave ablation group is less than thelaparoscopic group at the data of the operative time, intraoperative blood loss,postoperative ambulation and recovery diet time and1year after relapse rate. It is a safe,effective, less medical resources consumed and minimally noninvasive treatment. |
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