通讯作者: 蒲元芳, Pyfxx_123456@163.com

DOI：10.12201/bmr.202602.00004

Factors Influencing Early-Stage Seromuscular Layer Lesions in Focused Ultrasound Ablation for Adenomyosis

• 摘要：目的 子宫腺肌病(Adenomyosis,AM)是一种机制不确定的良性“内膜异位性疾病”,以月经改变和生育力损害为临床特点,患病率介于5~70%且年轻化。高强度聚焦超声(HIFU,High Intensity Focused Ultrasound)对各种KISHI分型AM均有较好疗效,但部分术后早期增强核磁共振(MRI,Magnetic Resonance Imaging)提示环状强化缺损,因此如何减少损伤是安全性的必要探讨。方法 本研究通过回顾性队列研究纳入重庆医科大学附属南川医院2015年-2025年233例AM确诊且HIFU治疗患者,根据术后增强MRI浆肌层是否完整分为损伤组(n=57)与非损伤组(n=176),通过单因素与多因素Logistic回归分析影响因素。结果 总损伤率为24.4%。单因素分析显示:最大病灶位置、KISHI分型、病灶体积、消融率、辐照时间、病灶距离腹前壁距离与损伤相关(P<0.05)。进一步多因素回归分析:消融率、最大病灶位置和病灶KISHI分型为独立因素(P<0.05),其中消融率(OR=7.963,95%CI: 1.100-57.648)与KISHI分型外生型(OR=4.514,95%CI: 1.779-11.453)是导致浆肌层损伤的独立危险因素。而最大病灶位置位于后壁是其中的保护因素(OR=0.274,95%CI: 0.120-0.626)。结论 HIFU消融后AM早期浆肌层损伤与消融率、病灶类型是独立危险因素,病灶位于后壁是相对保护因素。消融率越高,KIShi分型中外生型,需特别关注以优化提升安全性。

  关键词： 高强度聚焦超声消融；子宫腺肌病；浆肌层；组织损伤；安全性；影响因素; ; ; ; 

   

  Abstract: Objective Adenomyosis (AM) is a benign condition that resembles endometriosis; its pathogenesis remains elusive, and it most commonly presents with abnormal uterine bleeding and subfertility. Reported prevalence rates vary widely (5–70%), and the condition is increasingly diagnosed in younger women. High-intensity focused ultrasound (HIFU) has shown favourable efficacy across all KISHI subtypes of adenomyosis. However, early post-contrast MRI occasionally reveals ring-like non-enhancing defects, underscoring the need for additional strategies to minimise collateral tissue damage and enhance the safety profile of HIFU.Methods This retrospective cohort study enrolled 233 patients with magnetic resonance–confirmed adenomyosis who underwent high-intensity focused ultrasound (HIFU) ablation at Nanchuan Hospital, Chongqing Medical University, between 2015 and 2025. Early post-contrast MRI was used to assess the integrity of the junctional zone and outer myometrium. A total of 57 women showing ring-like non-enhancing defects were classified as the “injury” group, whereas the remaining 176 constituted the “no-injury” group. Univariable and multivariable logistic regression analyses were performed to identify predictors of myometrial injury.Results The total injury rate was 24.4%. Univariate analysis indicated that maximum lesion location, KISHI classification, lesion volume, ablation rate, sonication time, and distance from the anterior abdominal wall were associated with injury (P<0.05). Multivariate regression analysis identified ablation rate, maximum lesion location, and KISHI classification as independent factors (P<0.05). Specifically, higher ablation rates (OR=7.963, 95% CI: 1.100–57.648) and exophytic types in KISHI classification (OR=4.514, 95% CI: 1.779–11.453) were independent risk factors. Conversely, lesions located on the posterior wall conferred a protective effect (OR=0.274, 95% CI: 0.120–0.626).Conclusion Post-HIFU early myometrial injury in AM is independently correlated with ablation rate and lesion type, while posterior wall location appears to exert a protective effect. Enhanced safety protocols are warranted for patients with high ablation rates or exophytic KISHI classifications.

  Key words: High-intensity?focused?ultrasound?ablation?; Adenomyosis; Seromuscular layer; Tissue injury; Safety；Influencing?factors

  提交时间：2026-02-03

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• 序号	提交日期	编号	操作
  1	2025-12-30	10.12201/bmr.202602.00004V1	下载

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