聚焦超声消融手术联合子宫内膜部分切除治疗子宫腺肌病的前瞻性研究  

Prospective study of FUAS combined with TCRE in treating AM

作　　者：杜成超 蒋刘鹏 蒋静[1] 陈燕 周洪贵[1] DU Cheng-chao;JIANG Liu-peng;JIANG Jing(Department of Gynecology and Obstetrics,Affiliated Hospital of North Sichuan Medical College,Nanchong 637000,China;不详)

机构地区：[1]川北医学院附属医院妇产科,四川南充637000

出　　处：《中国医学装备》2021年第8期113-117,共5页China Medical Equipment

摘　　要：目的:探讨聚焦超声消融术(FUAS)联合宫腔镜子宫内膜部分切除术(TCRE)在子宫腺肌病(AM)治疗中的临床应用价值。方法:选取医院收治的142例AM患者,根据FUAS后是否行TCRE分为观察组(71例)和对照组(71例)。观察组采用FUAS后行TCRE;对照组采用FUAS后直接宫内放置左炔诺孕酮宫内节育系统(曼月乐LNG-IUS)。随访持续至治疗后12个月,随访指标为月经出血量,痛经评分和并发症发生率。结果:观察组中65例完成随访,对照组中57例完成随访。两组患者术后3个、6个月和12个月的月经量和痛经评分均明显下降,与术前相比差异有统计学意义(t=6.541,t=1.860,t=3.086;P<0.05)。两组患者治疗后3个月、6个月和12个月的月经出血量、痛经评分比较,差异无统计学意义。对照组患者术后不规则少量阴道流血率为30.9%,观察组为67.2%。对照组的平均阴道出血时间为89.7 d,观察组为4.6 d,两组术后平均阴道流血时间相比,差异有统计学意义(t=3.875,P<0.05)。结论:FUAS结合TCRE可明显改善AM的临床症状,且不良反应更小,是无生育要求患者治疗AM的有效方法。Objective:To explore the clinical application value of focused ultrasound ablation surgery(FUAS)combined with hysteroscopic transcervical resection of endometrium(TCRE)in the treatment of adenomyosis(AM).Methods:A total of 142 patients with AM selected and they were divided into observation group(71 cases)and control group(71 cases)according to whether underwent TCRE post FUAS.The observation group adopted undergoing TCRE post FUAS,and control group adopted directly placing levonorgestrel-releasing intrauterine system(LNG-IUS)within utero.The follow up visits were continued to the 12 th month after treatment.And the indicators of follow up visit were bleeding amount of menstruation,dysmenorrhea scores and incidences of complications.Results:65 patients of observation group completed follow-up visit and 57 patients of control group completed that.The menstrual blood volume and dysmenorrhea score of two groups at the 3 th month,the 6 th month and 12 th month post operation significantly decreased,and the differences of them between pre and post operation were significant(t=6.541,t=1.860,t=3.086,P<0.05).The differences of menstrual blood volume and dysmenorrhea score of each group post treatment among the 3 th month,6 th month and 12 th month were not significant.The rates of vaginal bleeding with irregular small amount of control group and observation group were 30.9%and 67.2%,respectively.The average time of vaginal bleeding of control group and observation group were 89.7 days and 4.6 days.The difference of average time of vaginal bleeding post operation between two groups was no significant(t=3.875,P<0.05).Conclusion:FUAS combined with TCRE can effectively improve clinical symptoms of AM and it has minor side effects.It can be an effective approach in the treatment of AM patients without the requirements of fertility.

关 键 词：子宫腺肌病(AM) 聚焦超声消融手术(FUAS) 宫腔镜子宫内膜切除术(TCRE) 左炔诺孕酮宫内节育器(LNG-IUS) 

分 类 号：R711.74[医药卫生—妇产科学]