초음파영상조준하 고강도집속초음파치료기 (HIFU)의 자궁근종 융해의 안전성에 대한 연구
Ultrasound imaging guided high intensity focused ultrasound (HIFU) may be a safe tool to ablate uterine myoma
2
조회
0
다운로드
3
인용
0
참고문헌
키워드
초록
목적: 초음파영상조준하 고강도집속초음파치료기 (HIFU)의 자궁근종 치료에 대한 안전성을 연구하고자 하였다. 연구 방법: 2008년 9월부터 2009년 2월까지 생리통 또는 생리과다를 호소하는 환자를 대상으로 HIFU를 실시하였다. HIFU는 1MHz에서 400 W/㎠의 강도로 70번의 치료를 하였으며, 150 msec의 치료시간과 치료간격을 반복하였다. 점과 점들을 치료하였으며 한 면이 끝나면 다음 면으로 4 mm 이동하여 치료하였다. 환자가 통증을 호소하면 치료를 일시 중단한 후에 다시 시작하였다. 결과: 11명의 환자의 나이 분포는 29세에서 48세였으며, 종괴의 크기는 최대직경이 36에서 115 mm였다. 아무도 통증이나 다른 이유로 치료를 포기하지 않았다. 치료는 한 단면에 40~60분 정도 소요되었고, 하루에 한 시간에서 한 시간 반 동안에 한 면에서 세 면을 치료하였다. 모든 환자는 투약없이 바로 귀가하였다. 환자들이 심각한 합병증을 호소하는 일이 없었다. 모든 환자는 치료 다음날 일상에 복귀하였다. 치료 후 첫 생리 이후로 질출혈도 호소하지 않았다. 결론: 초음파영상조준하 HIFU는 자궁근종 치료에 안전한 방법으로 생각된다.
Abstract
Objective: to test the safety of ultrasound imaging guided high intensity focused ultrasound (HIFU) to ablate uterine myoma. Methods: From September 2008 to February 2009, patients with dysmenorrhea and/or menorrhagia for uterine myomas had been enrolled. HIFU ablation was performed at 1 MHz. 400 W/㎠ of pulses were delivered for 150 m second with 150 m second interval at the target point for 70 cycles. This process was repeated on a point by point basis. After one slice was treated, the target was shifted 4 mm laterally. If patient were complaining of pain, the procedures were stopped for a while. Results: The distribution of age was 29~48 years old, and of longest diameter was 36.0~115.0 mm, and of target distance from skin was 55~100 mm, and of number of treatment was 2~6. Nobody gave up the procedure for pain or any other reason. The procedures took 40 to 60 minutes for a slice. One or three slices were treated in a day. All patients went home after HIFU without medication. Nobody reported any clinically severe complications. Everybody returned to normal activities 1 day after the procedure. Nobody complained of vaginal spotting after one cycle of menstruation. Conclusion: Ultrasound imaging-guided HIFU treatment appears to be safe to ablate the uterine myomas.
참고문헌 (22)
- Buttram VC Jr, "Uterine leiomyomata: etiology, symptomatology, and management", Fertil Steril, 36, pp.433~445 (1981)
- Vollenhoven BJ, "Uterine myomas: a clinical review", Br J Obstet Gynaecol, 97, pp.285~298 (1990)
- Nishiyama S, "High recurrence rate of uterine myomas on transvaginal ultrasound after abdominal myomectomy in Japanese women", Gynecol Obstet Invest, 61, pp.155~159 (2006)
- Mäkinen J, "Morbidity of 10 110 hysterectomies by type of approach", Hum Reprod, 16, pp.1473~1478 (2001)
- Smart OC, "Magnetic resonance guided focused ultrasound surgery of uterine myomas-the tissue effects of GnRH agonist pretreatment", Eur J Radiol, 59, pp.163~167 (2006)
- Lumsden MA, "Embolization versus myomectomy versus hysterectomy: which is best, when?", Hum Reprod, 17, pp.253~259 (2002)
- Mauskopf J, "The economic impact of uterine myomas in the United States: a summary of published estimates", J Womens Health (Larchmt), 14, pp.692~703 (2005)
- Stewart EA, "Focused ultrasound treatment of uterine myoma tumours: safety and feasibility of a noninvasive thermoablative technique", Am J Obstet Gynecol, 189, pp.48~54 (2003)
- Lynn JG, "A new method for the generation and use of focused ultrasound in experiment biology", J Gen Physiol, 26, pp.179~193 (1942)
- Fry WJ, "Ultrasonically produced localized selective lesions in the central nervous system", Am J Phys Med, 34, pp.413~423 (1955)
- Wu F, "Extracorporeal high intensity focused ultrasound ablation in the treatment of 1038 patients with solid carcinomas in China: an overview", Ultrason Sonochem, 11, pp.149~154 (2004)
- ter Haar G, "High intensity ultrasound", Semin Laparosc Surg, 8, pp.77~89 (2001)
- Goldberg SN, "Image-guided tumour ablation: standardization of terminology and reporting criteria", Radiology, 235, pp.728~739 (2005)
- ter Haar G, "Ultrasound focal beam surgery", Ultrasound Med Biol, 21, pp.1089~1100 (1995)
- Tempany CM, "MR imaging- guidedfocusedultrasound surgery of uterine leiomyomas: a feasibility study", Radiology, 226, pp.897~905 (2003)
- Hindley J, "MRI guidance of focused ultrasound therapy of uterine myomas: early results", AJR Am J Roentgenol, 183, pp.1713~1719 (2004)
- Fennessy FM, "Uterine leiomyomas: MR imaging-guided focused ultrasound surgery-results of different treatment protocols", Radiology, 243, pp.885~893 (2007)
- Zhang L, "Feasibility of magnetic resonance imaging-guided high intensity focused ultrasound therapy for ablating uterine myomas in patients with bowel lies anterior to uterus", Eur J Radiol (2008)
- Rabinovici J, "Clinical improvement and shrinkage of uterine myomas after thermal ablation by magnetic resonance-guided focused ultrasound surgery", Ultrasound Obstet Gynecol, 30, pp.771~777 (2007)
- Stewart EA, "Sustained relief of leiomyoma symptoms by using focused ultrasound surgery", Obstet Gynecol, 110, pp.279~287 (2007)
- Morita Y, "Non-invasive magnetic resonance imaging-guided focused ultrasound treatment for uterine myomas-early experience", Eur J Obstet Gynecol Reprod Biol, 139, pp.199~203 (2008)
- Fruehauf JH, "High-intensity focused ultrasound for the targeted destruction of uterine tissues: experiences from a pilot study using a mobile HIFU unit", Arch Gynecol Obstet, 277, pp.143~150 (2008)