子宫肌瘤聚焦超声消融手术与子宫肌瘤剔除术的远期临床疗效比较  

Comparison of the long-term outcomes of focused ultrasound ablation surgery for uterine fibroids and myomectomy

作　　者：刘欣[1] 汪伟[1] 唐杰[1] 王旸[1] 罗渝昆[1] 宋磊[2] Xin Liu;Wei Wang;Jie Tang;Yang Wang;Yukun Luo;Lei Song(Department of Ultrasound,First Medical Center of Chinese PLA General Hospital,Beijing 100853,China;Department of Obstetrics and Gynecology,First Medical Center of Chinese PLA General Hospital,Beijing 100853,China)

机构地区：[1]解放军总医院第一医学中心超声科,北京100853 [2]解放军总医院第一医学中心妇产科,北京100853

出　　处：《中华妇产科杂志》2022年第4期244-252,共9页Chinese Journal of Obstetrics and Gynecology

摘　　要：目的比较子宫肌瘤聚焦超声消融手术(FUAS)与子宫肌瘤剔除术的远期临床疗效差异。方法回顾性分析2007年1月至2015年1月在解放军总医院第一医学中心行FUAS(FUAS组, 763例)及子宫肌瘤剔除术(子宫肌瘤剔除术组, 1 205例)的子宫肌瘤患者的临床资料, 收集两组患者术前基本情况、影像学数据、手术情况, 随访两组术后症状改善、症状复发、再治疗以及不良事件发生情况, 并比较两组的差异。结果 FUAS组与子宫肌瘤剔除术组患者的治疗有效率分别为95.7%(730/763)、95.5%(1 151/1 205), 两组比较, 差异无统计学意义(χ2=0.027, P=0.869)。FUAS组治疗后1、3、5、8、10年的累积症状复发率分别为1.8%、6.8%、11.9%、15.2%、15.9%, 累积再治疗率分别为0.7%、4.1%、6.8%、9.9%、11.0%;子宫肌瘤剔除术组术后1、3、5、8、10年的累积症状复发率分别为1.8%、5.9%、10.6%、14.2%、14.9%, 累积再治疗率分别为0.9%、4.5%、7.8%、10.3%、11.4%;两组累积症状复发率及累积再治疗率均无明显差异(P均>0.05)。两组中肌壁间肌瘤患者的治疗有效率、症状复发率及再治疗率均无明显差异(P均>0.05);但FUAS组黏膜下肌瘤患者的治疗有效率(95.9%, 235/245)高于子宫肌瘤剔除术组(89.1%, 115/129), 症状复发率(11.9%, 28/235)低于子宫肌瘤剔除术组(27.8%, 32/115), 再治疗率(7.7%, 18/235)低于子宫肌瘤剔除术组(17.4%, 20/115), 分别比较, 差异均有统计学意义(P均<0.05);而FUAS组浆膜下肌瘤患者的治疗有效率(91.0%, 132/145)低于子宫肌瘤剔除术组(97.0%, 322/332), 症状复发率(32.6%, 43/132)高于子宫肌瘤剔除术组(9.9%, 32/322), 再治疗率(22.0%, 29/132)高于子宫肌瘤剔除术组(6.2%, 20/322), 分别比较, 差异均有统计学意义(P均<0.01)。FUAS总不良事件发生率[分别为1.8%(14/763)、21.9%(264/1 205)]及轻度、中度不良事件发生率低于子宫肌瘤剔除术组(P均<0.001)。结论 FUAS与子宫肌瘤剔除术均可长�Objective To compare the long-term outcomes after focused ultrasound ablation surgery(FUAS)versus myomectomy for uterine fibroids.Methods A retrospective study was conducted on women who were treated by FUAS or myomectomy for uterine fibroids at First Medical Center of Chinese PLA General Hospital from January 2007 to January 2015.Regular follow-up was conducted to evaluate the symptoms relief,symptoms recurrence,the need for re-interventions and complications of the two groups.Results The effective rates were 95.7%(730/763)and 95.5%(1151/1205)in women who were treated by FUAS and myomectomy,no statistical difference was seen between the two groups(χ²=0.027,P=0.869).The cumulative rates of symptoms recurrence at 1 year,3 years,5 years,8 years and 10 years of follow-up in FUAS group were 1.8%,6.8%,11.9%,15.2%and 15.9%,respectively;and the cumulative re-intervention rates were 0.7%,4.1%,6.8%,9.9%and 11.0%,respectively.The cumulative rates of symptoms recurrence at 1 year,3 years,5 years,8 years and 10 years of follow-up in myomectomy group were 1.8%,5.9%,10.6%,14.2%and 14.9%,respectively;and the cumulative re-intervention rates were 0.9%,4.5%,7.8%,10.3%and 11.4%,respectively.No statistical differences were seen between the two groups(all P>0.05).There were no significant differences in the effective rate,symptoms recurrence rate and re-intervention rate between the two groups in patients with intermural fibroids;but the effective rate of FUAS(95.9%,235/245)was higher than that of myomectomy(89.1%,115/129),the symptoms recurrence rate(11.9%,28/235)was lower than that of myomectomy(27.8%,32/115),and the re-intervention rate(7.7%,18/235)was lower than that of myomectomy(17.4%,20/115)in patients with submucosal fibroids,there were significant different(all P<0.05).The effective rate of FUAS(91.0%,132/145)was lower than that of myomectomy(97.0%,322/332),the symptoms recurrence rate(32.6%,43/132)was higher than that of myomectomy(9.9%,32/322),and the re-intervention rate(22.0%,29/132)was higher than that of myomectomy

关 键 词：平滑肌瘤 子宫肿瘤 高强度聚焦超声消融 子宫肌瘤切除术 疗效比较研究 

分 类 号：R737.33[医药卫生—肿瘤]