高強度集束超音波（HIFU）アブレーション後の子宮筋腫患者における腹腔内筋膜腫脹のMRI評価と影響因子の解析

MRI evaluation of endopelvic fascial swelling and analysis of influencing factors in patients with uterine fibroids after high-intensity focused ultrasound ablation.

• Ya-Jiao Zhang
• Zhi-Bo Xiao
• Fu-Rong Lv
• Bo Sheng
• Jia Li
• Yi-Neng Zheng
• Fa-Jin Lv
• Jin-Yun Chen

抄録

高強度集束超音波（HIFU）アブレーション後の子宮筋腫患者における腹膜内筋膜腫脹を磁気共鳴画像（MRI）で評価し、腹膜内筋膜腫脹に影響を及ぼす因子を検討すること。HIFU 治療を受けた子宮筋腫患者 188 例の MRI と臨床データをレトロスペクティブに解析した。筋膜性腫脹群と非腫脹群に分け、腫脹の程度を評価した。筋膜性腫脹を従属変数とし、ベースライン特性やHIFUパラメータなどの因子を独立変数とした。これらの変数と筋膜の腫脹との関係を一変量解析および多変量解析により解析した。因子と筋膜の腫脹の程度との相関は、Kruskal-Wallis検定で評価した。一変量解析では、子宮筋腫の位置、子宮筋腫から仙骨までの距離、超音波照射時間、治療時間、治療強度、治療量（TD）、エネルギー効率（EEF）のすべてが仙骨内筋膜腫脹に影響を与えていることが明らかになった（<0.05）。その後、多変量解析を行ったところ、線維腫から仙骨までの距離が筋膜性腫脹と有意な相関を示した（<0.05）。さらに、TDと超音波照射時間は筋膜の腫れの程度と有意に正の相関を示した（<0.05）。仙骨痛の発生率は筋膜性腫脹と有意に相関していた(<0.05)。線維腫から仙骨までの距離は筋膜性腫脹の保護因子であった。TDおよび超音波照射時間は筋膜性腫脹の程度と有意に正の相関があった。

To evaluate endopelvic fascial swelling in patients with uterine fibroids after high-intensity focused ultrasound (HIFU) ablation on magnetic resonance imaging (MRI) and investigate the factors that influence endopelvic fascial swelling. MRI and clinical data from 188 patients with uterine fibroids who were treated with HIFU were analyzed retrospectively. The patients were divided into a fascial swelling group and a non-swelling group, and the degree of swelling was graded. Fascial swelling was set as the dependent variable, and factors such as baseline characteristics and HIFU parameters, were set as the independent variables. The relationship between these variables and fascial swelling was analyzed by univariate and multivariate analyses. Correlations between the factors and the degree of fascial swelling were evaluated by Kruskal-Wallis test. The univariate analysis revealed that the fibroid location, distance from the fibroid to the sacrum, sonication time, treatment time, treatment intensity, therapeutic dose (TD), and energy efficiency (EEF) all affected the endopelvic fascial swelling ( < 0.05). Subsequently, multivariate analysis showed that the distance from the fibroid to the sacrum was significantly correlated with fascial swelling ( < 0.05). Moreover, TD and sonication time were significantly positively correlated with the degree of fascial swelling ( < 0.05). The incidence of sacrococcygeal pain was significantly correlated with fascial swelling ( < 0.05). The distance from the fibroid to the sacrum was a protective factor for fascial swelling. TD and sonication time were significantly positively correlated with the degree of fascial swelling.