3.0TMRI Evaluated The Change Of Pelvic Floor After Uterine Fibroids’ HIFU Postoperative

Objective: To explore the MRI evaluation of pelvic fascia, the sacrum and pelvis fluid change after uterine fibroids, high intensity focused ultrasound ablation(high intensity focused ultrasoundablation, HIFU),and further study the cause of the corresponding change and influence factors. To evaluate the value of MRI to observe the nuance change of pelvic structure.Materials and Methods: Retrospective analysis the pelvic MRI and clinical data of 283 uterine fibroids, patients that initial treatment of HIFU in North Sichuan Medical College hospital from January 2014 to June 2014. By means of MRI to observate and record the uterine fibroids, location, type, number, size and the change of pelvic fascia, sacrum, pelvic fluid. Recorded the total energy of HIFU treatment, irradiation time and age through the clinical data of patients. Statistical analysis the correlation of patients’ age, fibroids location, fibroids type, number of fibroids, fibroid volume, total energy of HIFU treatment, irradiation time with pelvic fascia, pelvic fluid.Results:(1) MRI observed 202 cases of pelvic fascia appear edema, presented strips, mesh high signal on T2 WI, T2 fat suppression present obviously high signal. Corresponding change with patients age, number of myoma, fibroid volume, type of fibroids have no relevance, the P values were 0.440, 0.050, 0.179, 0.201(> 0.05), the difference had no statistical significance. The pelvic fascia edema is correlated with total energy of HIFU treatment, irradiation time, the correlation coefficient r were 0.288, 0.317, P values were 0.000, 0.000(< 0.01)has obvious statistical significance, HIFU energy, irradiation time were positively associated with the degree of pelvic fascia edema; Fibroids location is also the factors in influencing pelvic fascia edema, the P value is 0.007(< 0.05), the difference has statistical significance.(2)MRI observed HIFU surgery in 283 patients with 57 cases of sacral signal is abnormal, but normal morphological structure of the sacrum. Sacrum of abnormal signal mainly in 3, 4, 5, the sacrum appear patchy, flake high signal in sagittal position on T2 WI.(3)MRI observed 46 patients of pelvic cavity accumulates fluid, was recorded in 46 cases of HIFU in which 38 cases(83%) pelvic cavity accumulates fluid confined to the uterus- rectal pouch, 6 cases(13%) is situated around the uterus- rectal pouch and uterus, 2 cases(4%) except around the uterus- rectal pouch and uterus, bladder and pelvic also see effusion between intestinal wall around; Statistical analysis of pelvic cavity accumulates fluid related factors: pelvic fluid with HIFU treatment of total energy has no correlation(r=0.065, p=0.278). Do not have relationship with HIFU irradiation time(r=0.056, p=0.347). And fibroid volume does not have correlation(r=0.072, p=0.228); With the patient age do not have correlation(r=0.038, p=0.519); With fibroids number does not have correlation(r=0.007, p=0.904).With the location of the uterine fibroids has no correlation(P=0.655); Associated with fibroids type does not have relations(p=0.262).Conclusion:(1)HIFU treated uterine fibroids can cause pelvic fascia edema and sacrum signal change, these changes through MRI can clearly display and observe, and MRI can effectively evaluate the pelvic fine structural change after HIFU treatment of uterine fibroids. This study indicates the pelvic fascia edema is most mild(1, 2), it is not relevant with uterine fibroid volume, number, types of fibroids and patients age, both pelvic fascia edema or not from the patients of HIFU postoperative has nothing to do with uterine fibroids volume, number, the myoma type and patients age; As with HIFU energy and irradiation time has positively relationship, namely the pelvic fascia edema and swelling degree with the increase of irradiation time and the energy of HIFU on extension and showed a trend of increase; Pelvic fascia edema circumstance also has relationship with fibroids location, front wall and back wall fibroids are more likely to cause pelvic fascia swelling in HIFU treatment than other wall fibroids, the degree of pelvic fascia edema relatively heavy in after wall myoma after HIFU;HIFU irradiation time, treatment of total energy and uterine fibroids location are the main influencing factors in oedema of pelvic fascia.(2)The sacrum signal change just in a few cases, appearance probability only 20%.MRI performance present strip, flake abnormal signal in front of sacral vertebral centrum, T2 WI show high signal, high or low, mixed signals,T1 WI was slightly low signal; Some researchers think the sacrum signal abnormalities with uterine fibroids location, the size of the myoma and maximum power of HIFU treatment had no significant correlation, and the distance between myoma sacrum, HIFU on power and irradiation time may play a certain role.(3)This research shows that MRI was observed only a minority of patients(16%) had pelvic cavity accumulates fluid after HIFU treatment, most(83%) of them confined to the uterus- rectal pouch. Further statistical analysis showed that pelvic fluid produced with age, number of fibroids, fibroid volume, type of fibroids, HIFU treatment power and irradiation time don’t have correlation, to some extent could be related to patients’ physical condition(or 5 days before the menstrual oviposit period, etc.), and the case is less, so the HIFU treatment of uterine fibroids may not be the cause of pelvic cavity accumulates fluid. HIFU ablation uterine flesh tumour is still a relatively safe and reliable treatment.