经皮影像引导冷冻消融治疗脐部子宫内膜异位症的安全性与疗效
单中心17例脐部子宫内膜异位症女性接受超声或超声联合CT引导经皮冷冻消融，中位随访22个月时82%完全疼痛缓解，MRI结节体积中位缩小73%，82.4%患者美容满意，不良事件17.7%以轻微为主。
要点
- 脐部子宫内膜异位症可考虑经皮冷冻消融作为微创门诊替代方案。
- 术后MRI评估结节体积中位缩小73%，疼痛VAS中位由8.0降至0.0。
- 不良事件以SIR B级浅表冻伤为主，需注意皮肤保护。
关键影像表现/征象
- 超声示病灶中位体积2.42 cm3（IQR 0.82-4.70），MRI示2.98 cm3（IQR 1.14-5.49）。
- MRI随访结节中位体积由2.98 cm3降至0.90 cm3，中位个体缩小73.0%（IQR 39.3-88.4%）。
- 美容结局82.4%（14/17）患者评为满意（4分）或非常满意（5分）。
诊断标准与关键数值
- 完全疼痛缓解定义为随访时疼痛消失，14/17例（82%）在中位随访22个月（IQR 12.0-31.0）达到。
- VAS峰值中位由8.0（IQR 6.5-9.0）降至0.0（IQR 0.0-0.0），p<0.001。
- 不良事件按SIR分类：3例（17.7%），2例轻微（B级，浅表冻伤），1例严重（C级，需外科清创）。
临床应用与阅片要点
- 术前联合超声与MRI测量结节体积，术后用MRI随访体积变化。
- 术中注意保护脐周皮肤，减少浅表冻伤风险。
- 多数操作可在门诊完成（16/17，94%），但70%（12/17）需全身麻醉。
局限性
- 单中心小样本（17例），无对照组。
- 随访时间中位22个月，长期疗效未明。
以上解读依据论文摘要（全文未开放获取或许可不允许翻译转载）。
英文原文（摘要）· 点击展开
OBJECTIVES: To evaluate the safety, feasibility and imaging outcomes of percutaneous image-guided cryoablation as a minimally invasive treatment for umbilical endometriosis (UE).
MATERIALS AND METHODS: Between March 2017 and December 2024, 17 women (median age: 38 years; [IQR, 32-38]) underwent percutaneous cryoablation of UE at a single institution. Procedures were performed under ultrasound (US) alone or combined US/CT-scan guidance. Pain severity was assessed using the visual analog scale (VAS), imaging (US and MRI) and cosmetic outcomes were compared before and after treatment. Adverse events were reported according to the Society of Interventional Radiology classification (SIR).
RESULTS: Median lesion volume was 2.42 cm3 [IQR, 0.82-4.70] on US and 2.98 cm3 [IQR, 1.14-5.49] on MRI. 12/17 procedures (70%) were performed under general anesthesia and 16/17 on an outpatient basis (94%). Complete pain relief was achieved in 14/17 patients (82%) at a median follow-up of 22 months [IQR, 12.0-31.0]. The median peak VAS score decreased significantly from 8.0 [IQR, 6.5-9.0] to 0.0 [IQR, 0.0-0.0]; p < 0.001. On MRI, median nodule volume decreased from 2.98 cm3 to 0.90 cm3, representing a median individual reduction of 73.0% [IQR, 39.3-88.4%]. Regarding cosmetic outcomes, 82.4% (14/17) of patients were "satisfied" (score 4) or "very satisfied" (score 5). Three adverse events (17.7%) were recorded, two minor (SIR Grade B; superficial frostbite) and one major (SIR Grade C; surgical debridement).
CONCLUSION: Percutaneous image-guided cryoablation appears to be safe and feasible for umbilical endometriosis, offering significant pain relief, substantial nodule volume reduction and satisfactory cosmetic outcomes with predominantly minor adverse events.
KEY POINTS: Question Umbilical endometriosis causes disabling pain and cosmetic concerns. Surgical excision is invasive and minimally invasive image-guided alternatives with proven efficacy and safety remain lacking. Findings Percutaneous cryoablation of umbilical endometriosis achieved durable pain relief (82%), significant nodule reduction (73%), and high cosmetic satisfaction in 82% of patients, with few adverse events, confirming its feasibility and safety. Clinical relevance Percutaneous cryoablation represents a minimally invasive, outpatient alternative to surgery for umbilical endometriosis, offering durable symptom relief and improved cosmetic outcomes, with low morbidity, potentially improving patients' quality of life and broadening therapeutic options for this rare entity.
引用
- de Rycke AC, Faure A, Najdawi M, et al. Percutaneous image-guided cryoablation of umbilical endometriosis: safety, feasibility, clinical, and imaging outcomes. Eur Radiol. 2026. PMID: 42113241. doi:10.1007/s00330-026-12592-7
供执业医师工作参考，不替代临床判断；数值与分级以指南原文为准。