高强度聚焦超声技术在妇产科疾病中的应用进展

doi:10.12280/gjfckx.20240505

摘要/Abstract

摘要：

高强度聚焦超声（high intensity focused ultrasound，HIFU）技术是一种无创的热组织消融方法，可以通过磁共振引导高强度聚焦超声（magnetic resonance guided high intensity focused ultrasound，MRgHIFU）或超声引导高强度聚焦超声（ultrasound guided high intensity focused ultrasound，USgHIFU）实现在线图像引导和治疗控制，HIFU具有非侵入性、非电离和治疗后并发症少的优点。作为一种非手术治疗方法，在过去的10年里，HIFU技术越来越多地被应用于妇产科疾病的治疗中。HIFU通过精准聚焦超声波能量实现组织消融，对于子宫肌瘤、宫颈病变、子宫腺肌病、外阴非肿瘤性上皮疾病、剖宫产瘢痕妊娠、腹壁子宫内膜异位症、子宫动静脉瘘、双胎反向动脉灌注序列征等妇产科疾病具有良好的疗效，其优点体现在减少并发症、适合有手术禁忌证患者以及缩短恢复时间，并且对未育女性也具有重要意义。尽管HIFU在妇产科疾病治疗中展现出积极前景，但仍需进一步研究以评估其长期效果和安全性。未来，HIFU有望成为妇科疾病治疗的新选择，造福更多患者。

关键词: 体外冲击波疗法, 平滑肌瘤, 子宫腺肌病, 宫颈上皮内瘤样病变, 乳头状瘤病毒科, 子宫内膜异位症, 外阴非肿瘤性上皮疾病, 剖宫产瘢痕妊娠, 子宫动静脉瘘, 双胎反向动脉灌注序列征

Abstract:

High intensity focused ultrasound (HIFU) technology is a non-invasive thermal tissue ablation method that can achieve image-guided therapy and treatment control through magnetic resonance guided high intensity focused ultrasound (MRgHIFU) or ultrasound guided high intensity focused ultrasound (USgHIFU). HIFU offers the advantages of being non-invasive, non-ionizing, and associated with fewer post-treatment complications. As a non-surgical treatment modality, HIFU technology has been increasingly applied in the treatment of obstetric and gynecological diseases over the past decade. HIFU achieves tissue ablation through precise focusing of ultrasound energy and has demonstrated efficacy in treating conditions such as uterine fibroids, cervical lesions, adenomyosis, non-neoplastic epithelial disorders of the vulva, caesarean scar pregnancy, abdominal wall endometriosis, uterine arteriovenous fistula, twin reversed arterial perfusion sequence, among others. Its benefits include reduced complications, suitability for patients with surgical contraindications, and shorter recovery times, which is particularly significant for women who have not yet had children. Although HIFU shows a promising outlook in the treatment of obstetric and gynecological diseases, further research is needed to assess its long-term effectiveness and safety. In the future, HIFU is expected to become a new treatment option for gynecological diseases, benefiting more patients.

Key words: Extracorporeal shock wave therapy, Leiomyoma, Adenomyosis, Cervical intraepithelial neoplasia, Papillomaviridae, Endometriosis, Non-neoplastic epithelial disorders of the vulva, Caesarean scar pregnancy, Uterine arteriovenous fistula, Twin reversed arterial perfusion sequence

李慧敏, 胡雅莉, 张森淮, 马晓梅, 许飞雪. 高强度聚焦超声技术在妇产科疾病中的应用进展[J]. 国际妇产科学杂志, 2024, 51(5): 486-491.

LI Hui-min, HU Ya-li, ZHANG Sen-huai, MA Xiao-mei, XU Fei-xue. Progress in the Application of High Intensity Focused Ultrasound Technology in Obstetric and Gynecological Diseases[J]. Journal of International Obstetrics and Gynecology, 2024, 51(5): 486-491.

图/表 1

参考文献 36

[1]	Zhou YF. High intensity focused ultrasound in clinical tumor ablation[J]. World J Clin Oncol, 2011, 2(1):8-27. doi: 10.5306/wjco.v2.i1.8.
[2]	Al-Bataineh O, Jenne J, Huber P. Clinical and future applications of high intensity focused ultrasound in cancer[J]. Cancer Treat Rev, 2012, 38(5):346-353. doi: 10.1016/j.ctrv.2011.08.004. pmid: 21924838
[3]	She WH, Cheung TT, Jenkins CR, et al. Clinical applications of high-intensity focused ultrasound[J]. Hong Kong Med J, 2016, 22(4):382-392. doi: 10.12809/hkmj154755. pmid: 27380753
[4]	Elhelf I, Albahar H, Shah U, et al. High intensity focused ultrasound: The fundamentals, clinical applications and research trends[J]. Diagn Interv Imaging, 2018, 99(6):349-359. doi: 10.1016/j.diii.2018.03.001.
[5]	Patel N, Chaudhari K, Patel D, et al. High-Intensity Focused Ultrasound Ablation of Uterine Fibroids: A Review[J]. Cureus, 2023, 15(9):e44680. doi: 10.7759/cureus.44680.
[6]	Ren Y, Li Y, Pu Y. A contrastive study on the clinical efficacy and safety of laparoscopic myomectomy and high intensity focused ultrasound in the treatment of uterine fibroids[J]. Ginekol Pol, 2023, 94(5):358-365. doi: 10.5603/GP.a2022.0034.
[7]	De Maio A, Alfieri G, Mattone M, et al. High-Intensity Focused Ultrasound Surgery for Tumor Ablation: A Review of Current Applications[J]. Radiol Imaging Cancer, 2024, 6(1):e230074. doi: 10.1148/rycan.230074.
[8]	Marinova M, Ghaei S, Recker F, et al. Efficacy of ultrasound-guided high-intensity focused ultrasound (USgHIFU) for uterine fibroids: an observational single-center study[J]. Int J Hyperthermia, 2021, 38(2):30-38. doi: 10.1080/02656736.2021.1939444.
[9]	寇莉, 敬源, 张亚红. 高强度超声聚焦治疗子宫肌瘤疗效[J]. 中国计划生育学杂志, 2021, 29(5):911-913. doi:10.3969/j.issn.1004-8189.2021.05.014.
[10]	吴萍, 陈艳, 陈丰华, 等. 聚焦超声消融对阔韧带子宫肌瘤的临床疗效[J]. 中华医学超声杂志(电子版), 2021, 18(12):1203-1207. doi: 10.3877/cma.j.issn.1672-6448.2021.12.014.
[11]	Qu K, Zou M, Wang Z, et al. Evaluation of the timing and safety of hysteroscopic myomectomy of large submucosal fibroids pretreated by high intensity focused ultrasound[J]. Int J Hyperthermia, 2023, 40(1):2249275. doi: 10.1080/02656736.2023.2249275.
[12]	Li W, Yang Z, Gao B, et al. Comparison of ultrasound-guided high-intensity focused ultrasound ablation and hysteroscopic myomectomy for submucosal fibroids: a retrospective study[J]. Int J Hyperthermia, 2021, 38(1):1609-1616. doi: 10.1080/02656736.2021.1995053.
[13]	Qu D, Liu Y, Jiang J, et al. Pregnancy outcomes following ultrasound-guided high-intensity focused ultrasound in submucous leiomyomas: a retrospective study[J]. Int J Hyperthermia, 2023, 40(1):2193363. doi: 10.1080/02656736.2023.2193363.
[14]	Zeng H, Liu M, Xiao L, et al. Effectiveness and immune responses of focused ultrasound ablation for cervical intraepithelial neoplasia[J]. Int J Hyperthermia, 2022, 39(1):539-546. doi: 10.1080/02656736.2022.2052365.
[15]	冯美宁, 郜欣. 宫颈环形电切术后应用重组干扰素α-2b栓治疗高危型人乳头瘤病毒感染宫颈上皮内瘤变的效果[J]. 中国肿瘤临床与康复, 2020, 27(5):552-555. doi: 10.13455/j.cnki.cjcor.2020.05.11.
[16]	Liu Y, Wang W, Zhang M, et al. High-Intensity Focused Ultrasound for Patients With Cervical Intraepithelial Neoplasia 2/3: A Prospective One-Arm Study[J]. Ultrasound Med Biol, 2023, 49(1):375-379. doi: 10.1016/j.ultrasmedbio.2022.09.020. pmid: 36283939
[17]	Liu M, Zhang X, Feng Q, et al. A cervical high-grade squamous intraepithelial lesion with infertility treated with focused ultrasound[J]. Asian J Surg, 2022, 45(1):488-489. doi: 10.1016/j.asjsur.2021.08.064.
[18]	Zhong Q, Tang F, Ni T, et al. Salvage high intensity focused ultrasound for residual or recurrent cervical cancer after definitive chemoradiotherapy[J]. Front Immunol, 2022,13:995930. doi: 10.3389/fimmu.2022.995930.
[19]	Zhu H, Ma Q, Dong G, et al. Clinical evaluation of high-intensity focused ultrasound ablation combined with mifepristone and levonorgestrel-releasing intrauterine system to treat symptomatic adenomyosis[J]. Int J Hyperthermia, 2023, 40(1):2161641. doi: 10.1080/02656736.2022.2161641.
[20]	Zhao Y, Luo S, Liu Y, et al. High intensity focused ultrasound treatment for adenomyosis: comparison of efficacy based on MRI features[J]. Int J Hyperthermia, 2023, 40(1):2197574. doi: 10.1080/02656736.2023.2197574.
[21]	Gong C, Wang Y, Lv F, et al. Evaluation of high intensity focused ultrasound treatment for different types of adenomyosis based on magnetic resonance imaging classification[J]. Int J Hyperthermia, 2022, 39(1):530-538. doi: 10.1080/02656736.2022.2052366.
[22]	Feng T, Wang L, Zhu D, et al. Factors influencing the clinical efficacy of high-intensity focused ultrasound in the treatment of non-neoplastic epithelial disorders of the vulva: a retrospective observational study[J]. Int J Hyperthermia, 2021, 38(1):1457-1461. doi: 10.1080/02656736.2021.1985628.
[23]	Li L, He S, Jiang J. Comparison of efficacy and safety of high-intensity focused ultrasound at different powers for patients with vulvar lichen simplex chronicus[J]. Int J Hyperthermia, 2021, 38(1):781-785. doi: 10.1080/02656736.2021.1926561.
[24]	Li R, Jiang J. The efficacy and safety of secondary focused ultrasound therapy for recurrence of non-neoplastic epithelial disorders of the vulva[J]. Int J Hyperthermia, 2022, 39(1):1310-1314. doi: 10.1080/02656736.2022.2131000.
[25]	He S, Jiang J. High-intensity focused ultrasound therapy for pediatric and adolescent vulvar lichen sclerosus[J]. Int J Hyperthermia, 2022, 39(1):579-583. doi: 10.1080/02656736.2022.2060528.
[26]	Yin Y, Pan F, He M, et al. High intensity focused ultrasound combined with ultrasound-guided suction curettage treatment for cesarean scar pregnancy: a comparison of different HIFU sonication strategies[J]. Int J Hyperthermia, 2022, 39(1):390-396. doi: 10.1080/02656736.2022.2044078.
[27]	Peng Y, Dai Y, Yu G, et al. Analysis of the type of cesarean scar pregnancy impacted on the effectiveness and safety of high intensity focused ultrasound combined with ultrasound-guided suction curettage treatment[J]. Int J Hyperthermia, 2022, 39(1):1449-1457. doi: 10.1080/02656736.2022.2107715.
[28]	Ali MM, Awad Elderiny H, Shaaban Abdelgalil M, et al. Is high-intensity focused ultrasound a magical solution to endometriosis? A systematic review[J]. Proc(Bayl Univ Med Cent), 2024, 37(4):625-637. doi: 10.1080/08998280.2024.2352290.
[29]	Wang S, Li BH, Wang JJ, et al. The safety of echo contrast-enhanced ultrasound in high-intensity focused ultrasound ablation for abdominal wall endometriosis: a retrospective study[J]. Quant Imaging Med Surg, 2021, 11(5):1751-1762. doi: 10.21037/qims-20-622.
[30]	Yang Q, Zhang X. Efficacy and safety of high-intensity focused ultrasound ablation for rectus abdominis endometriosis: a 7-year follow-up clinical study[J]. Quant Imaging Med Surg, 2023, 13(3):1417-1425. doi: 10.21037/qims-22-695.
[31]	Sentilhes L, Kayem G, Chandraharan E, et al. FIGO consensus guidelines on placenta accreta spectrum disorders: Conservative management[J]. Int J Gynaecol Obstet, 2018, 140(3):291-298. doi: 10.1002/ijgo.12410. pmid: 29405320
[32]	Guan X, Huang X, Ye M, et al. Treatment of Placenta Increta With High-Intensity Focused Ultrasound Ablation and Leaving the Placenta in situ: A Multicenter Comparative Study[J]. Front Med(Lausanne), 2022,9:871528. doi: 10.3389/fmed.2022.871528.
[33]	Li L, Wang T, Xu D. A case of high-intensity focused ultrasound therapy for uterine arteriovenous fistula[J]. Asian J Surg, 2023, 46(11):5080-5081. doi: 10.1016/j.asjsur.2023.06.087. pmid: 37419821
[34]	Seo K, Ichizuka K, Okai T, et al. Treatment of twin-reversed arterial perfusion sequence using high-intensity focused ultrasound[J]. Ultrasound Obstet Gynecol, 2019, 54(1):128-134. doi: 10.1002/uog.20101. pmid: 30136326
[35]	赵凤翔. 育龄期HSIL患者宫颈锥切术后阴道微生态及宫颈机能恢复情况的临床研究[D]. 桂林: 桂林医学院, 2022.
[36]	Wei J, Wang L, Tao H, et al. Comparison of pregnancy outcomes in infertile patients with different types of adenomyosis treated with high-intensity focused ultrasound[J]. Int J Hyperthermia, 2023, 40(1):2238140. doi: 10.1080/02656736.2023.2238140.