高强度聚焦超声消融子宫内膜在子宫腺肌病治疗疗效中的临床评价  

The clinical evaluation of high intensity focused ultrasound ablation of endometrium in the treatment of adenomyosis

作　　者：苏园园[1] 刘君[1] 唐妍[1] 阳丽君[1] 黄瑾[1] 罗少玲[1] SU Yuan-yuan;LIU Jun;TANG Yan;YANG Li-jun;HUANG Jin;LUO Shao-ling(Department of Obstetrics & Gynecology,People s Hospital of Zhongshan City,Zhongshan 528403,China)

机构地区：[1]中山市人民医院妇产科,528403

出　　处：《妇产与遗传（电子版）》2018年第4期6-10,共5页Obstetrics-Gynecology and Genetics (Electronic Edition)

摘　　要：目的回顾性分析高强度聚焦超声(high intensity focused ultrasound,HIFU消融治疗子宫腺肌病的疗效,探讨子宫内膜消融在HIFU治疗中的价值及安全性。方法采用JC200型HIFU肿瘤治疗系统治疗107例临床诊断明确的子宫腺肌病患者,治疗后3、6、12个月对患者进行随访,按治疗后复查MRI增强显示有没有消融子宫内膜分为单纯HIFU治疗病灶组(A组)和HIFU治疗同时进行子宫内膜消融组(B组),比较治疗前后两组患者的临床症状变化及病灶影像学变化。结果治疗107例患者,完成随访105例患者,其中A组36例,B组69例。病灶的吸收情况B组显著优于A组,在术后6月达到峰值,差异有统计学意义(P <0. 05),术后12月,两组之间无明显差异(P> 0. 05);经量的变化方面,术后3月时B组有60. 9%的患者经量减少(P <0. 05),而A组仅44. 4%,术后6月及12月两组之间比较无差异(P> 0. 05);痛经缓解率在两组之间无显著差异;术后感染情况B组继发感染1例,发生率1. 4%。进一步将子宫内膜消融组分为子宫内膜消融范围<50%和> 50%两组,两组之间HIFU术后3月、6月、12月经量变化,病灶范围,痛经症状有无缓解之间的差异均无统计学意义(P> 0. 05)。结论 HIFU是一种治疗子宫腺肌病的无创、有效、可行手段。HIFU治疗同时进行子宫内膜消融更利于病灶的缩小,控制症状,且未增加术后感染概率,然而当子宫内膜消融面积> 50%,其经量变化、病灶范围、痛经缓解率并没有显著优于子宫内膜消融面积<50%时,这有待进一步扩大样本量来研究。Objective To investigate the efficacy of high-intensity focused ultrasound(HIFU)ablation in patients with adenomyosis,and the value and safety of endometrium ablation in HIFU therapy.Methods 107 cases of adenomyosis were treated with JC200-type HIFU tumor treatment system,followed by 3,6 and 12 months after treatment.According to whether there was ablation of endometrium evaluated by MRI after treatment or not,the patients were divided into two groups:group of HIFU alone(Group A)and group of HIFU with the treatment of endometrium ablation(Group B).The clinical symptoms and MRI image of the patients in two groups were compared before and after treatment.Results A total of 105 patients were followed up,including 36 in Group A and 69 in Group B.A better absorption rate was showed in the absorption of the lesion in Group B than that in Group A,the peak absorption rate was reached in the 6 months later,and the difference was statistically significant(P<0.05),however,in the 12 months later,there was no significant difference was observed between the two groups(P>0.05).In the change of menstrual blood volume(MBV),60.9%patients in Group B showed a reduction of MBV in the 3 months after treatment,while in Group A,only 44.4%patients showed a reduction of MBV,and significant difference was observed(P<0.05),however,in the 6 months and 12 months after treatment there was no difference showed in MBV between the two groups(P>0.05).There was no significant difference between the two groups in dysmenorrhea remission rate.Only 1 case in Group B had secondary infection(1.4%).69 patients in Group B were further divided into two groups:group of endometrium ablation area<50%and>50%,no significant differences were showed between the two groups in the change of MBV,the lesion scope and the remission of dysmenorrhea symptom in the 3,6,12 months later(P>0.05).Conclusions HIFU is a noninvasive,effective and feasible method for the treatment of adenomyosis.HIFU with the treatment of endometrium ablation at the same time is more beneficial t

关 键 词：子宫腺肌病 子宫内膜消融 高强度聚焦超声 

分 类 号：R711[医药卫生—妇产科学]