CAREER: Establishing the Efficacy of Cryomyolysis - Cryosurgery of Uterine Fibroids

子宫肌瘤是妇科最常见的器官疾病，也是女性进行大手术最常见的原因。目前的治疗方法包括子宫切除术（手术切除子宫），子宫肌瘤切除术（手术切除肌瘤），以及最近的肌溶术（破坏肌瘤在体内）。建议的工作将调查肌瘤冷冻手术或冷冻溶解术的潜力，作为一种保守的替代方案，为妇女患有肌瘤，但不希望接受手术切除肌瘤或子宫。假设是：1。2.冷冻溶解的有效性主要是由于血管损伤（对滋养肌瘤的血管网络的损伤）而不是直接细胞损伤（对肌瘤细胞本身的损伤）。细胞破坏的程度可以根据冻融过程中施加在组织上的热历史来预测。通过在提案的具体目标中测试这些假设，我们将能够回答以下问题：保持多低的温度和多长时间是破坏单个肌瘤细胞和组织所必需的？当细胞和组织在体内（体内）和在体外（体外）时，冷冻手术破坏细胞和组织的能力有区别吗？如果存在差异，是否可以归因于体内血管损伤机制？最后，在手术过程中形成的冰球的大小与技术破坏的组织数量有什么关系？这些问题的答案对于彻底了解冷冻手术破坏的机制至关重要，因此对于谨慎有效地应用这种手术技术治疗子宫肌瘤至关重要。* * *

9703326 Bischof Uterine fibroids are the most common organ disease in gynecology and the most common reason for major surgery in women. Current treatments include hysterectomy (surgical removal of the uterus), myomectomy (surgical removal of the fibroid), and most recently myolysis (destruction of the fibroid in the body). The proposed work will investigate the potential of cryosurgery of the fibroid or cryomyolysis as a conservative alternative for women who suffer from fibroids but do not wish to undergo a surgical operation to remove either the fibroid or their uterus. The hypotheses are: 1. The effectiveness of cryomyolysis is due primarily to vascular injury (damage to the vascular network nourishing the fibroid) as opposed to direct cellular injury (damage to the fibroid cells themselves), and 2. The extent of cellular destruction can be predicted based on the thermal history imposed on the tissue during cryomyolysis. By testing these hypothesis in the specific aims of the proposal, we will be able to answer the following questions: How low a temperature held for what length of time is necessary to destroy single fibroid cells and tissues? Is there a difference in the ability of cryosurgery to destroy the cells and tissues when they are in the body (in vivo) vs. when they are outside of the body (in vitro)? If a difference exists, can it be attributed to a vascular in injury mechanism inside the body (in vivo)? And finally, how does the size of the ice ball that is formed during the surgery correlate to the amount of tissue destroyed as a result of the technique? The answers to these questions are critical to a thorough understanding of the mechanism of cryosurgical destruction and, consequently, to the prudent and effective application of this surgical technique in uterine fibroids. ***