子宫肌瘤栓塞前后MR临床表现课件.ppt

子宫平滑肌肉瘤 子宫明显增大，肿块（LMS）边界不清，内见坏死（b箭） Treatment Options for Leiomyomas治疗方法 Surgical Treatments手术 Hysterectomy子宫切除术 The surgery can be performed via the vaginal or abdominal route. In selected cases, the uterus can be removed with a laparoscopic approach. 手术可经腹或经阴道做，部分病人可行腹腔镜子宫切除术。 Myomectomy肌瘤切除术. Myomectomy is indicated in women with a history of second-trimester fetal loss, anemia secondary to hypermenorrhea, or pelvic pain.The risk of recurrence after myomectomy has been estimated to be 27% after 10 years. 肌瘤切除术适用于有孕中期胎儿流产史、月经过多继发贫血及腹痛的病人。切除后肌瘤10年内复发率约27%。 Nonsurgical Treatments非手术治疗 Gonadotropin-releasing Hormone Analogs促性腺激素释放激素类似物 Gonadotropin-releasing hormone agonists are often used as preoperative adjunctive therapy to surgery. They cause down-regulation of estrogen receptors, which decreases growth of leiomyomas. However, after cessation of treatment, there is rapid regrowth of the tumor. 促性腺激素释放激素类似物治疗常于术前应用，可下调雌激素受体水平，抑制肌瘤生长。但停药后肌瘤会迅速长大。 Uterine Fibroid Embolization（UFE）子宫肌瘤栓塞术 UFE is a popular and effective method of treating symptomatic leiomyomas. The procedure involves delivery of embolic particles via the uterine arteries to occlude end-arterioles that perfuse the leiomyomas, thus causing necrosis of the leiomyomas. Symptom relief as well as a decrease in the size of the leiomyomas and the uterus overall occur in a majority of patients. UFE通过子宫动脉注入颗粒，栓塞肌瘤血管，致肌瘤坏死。术后多数患者症状减轻，肿瘤体积缩小。 MR Imaging–guided Focused Ultrasound MR介导的超声聚焦治疗 It is intended for premenopausal women who have completed childbearing. Other than medical management, this is the only completely noninvasive treatment option available. The therapy is extremely accurate, as real-time MR imaging is performed during the procedure to map out and confirm that the ultrasound waves are targeting the leiomyoma precisely. Because this is a new technique, long-term outcomes have not been studied. 用于绝经前妇女，超声聚焦治疗可精确彻底地切除肿瘤。 MR Imaging Findings Pertinent to Success of UFE ，MR筛选适合子宫肌瘤栓塞的患者 Pedun