HIFU联合药物治疗不同类型子宫腺肌病的临床研究  

Clinical study of HIFU combined with drugs in the treatment of different types of adenomyosis

作　　者：蒋奕阳 彭丽秀[1] Jiang Yiyang;Peng Lixiu(Department of Gynecology,The First Peoples Hospital of Chenzhou,Chenzhou Hunan 423000,P.R.China)

机构地区：[1]郴州市第一人民医院妇科,湖南郴州423000

出　　处：《中国计划生育和妇产科》2022年第8期79-84,共6页Chinese Journal of Family Planning & Gynecotokology

基　　金：郴州市海扶研发中心项目(项目编号:SD201632)。

摘　　要：目的 探讨高强度聚焦超声(high intensity focused ultrasound, HIFU)及其联合促性腺激素释放激素激动剂(gonadotropin-releasing hormone agonist, GnRH-a)及左炔诺孕酮宫内缓释系统(levonorgestrel-releasing intrauterine system, LNG-IUS)治疗弥漫型及局限型子宫腺肌病的临床效果。方法 分析2018年2月至2019年4月在郴州市第一人民医院行HIFU治疗的136例子宫腺肌病患者的临床资料,将其分为弥漫型子宫腺肌病组(D组,97例)和局限型子宫腺肌病组(F组,39例)。根据两组患者HIFU术后接受的不同治疗再各分为4个小组,D1/F1组:单纯HIFU治疗组;D2/F2组:HIFU+GnRH-a治疗组;D3/F3组:HIFU+LNG-IUS治疗组;D4/F4组:HIFU+GnRH-a+LNG-IUS治疗组。观察术后消融率及3、6、12个月后患者痛经及月经量改善情况。结果 136例患者均顺利完成HIFU治疗。D组与F组的辐照时间、无灌注区体积分别为:(505.53±261.21)s、(60.16±48.61)cm^(3),(520.80±262.74)s、(51.35±40.67)cm^(3),差异均无统计学意义(P>0.05);D组与F组消融率分别为(71.71±22.84)%、(83.68±20.80)%,差异有统计学意义(P<0.05)。术后3、6、12个月D组痛经症状改善有效率分别为92.3%、88.7%、79.4%,F组为97.4%、92.3%、94.9%,D组与F组术后3、6个月痛经改善差异均无统计学意义(P>0.05),术后12个月F组痛经改善有效率优于D组(P<0.05)。术后3、6、12个月月经改善情况:D组为88.7%、86.6%、82.5%,F组为92.3%、92.3%、87.2%,D组与F组在术后相同时间段月经量改善差异无统计学意义(P>0.05)。D组与F组在接受相同治疗后12个月痛经改善情况分别为:D1(62.9%)/F1(93.3%)、D2(83.3%)/F2(90.0%)、D3(85.7%)/F3(100%)、D4(93.5%)/F4(100%),除D1组与F1组差异有统计学意义(P<0.05),余3组间差异均无统计学意义(P>0.05)。术后12个月月经量改善率分别为:D1(68.6%)/F1(73.3%)、D2(83.3%)/F2(90.0%)、D3(85.7%)/F3(100%)、D4(96.8%)/F4(100%),各组间月经量改善差异无统计学意义(P>0.05)。观察136例患者12个月时Objective To explore high intensity focused ultrasound(HIFU) and its combination with gonadotropin-releasing hormone agonist(GnRH-a) and levonorgestrel-releasing intrauterine system(LNG-IUS) in the treatment of diffuse and localized adenomyosis.Methods The clinical data of 136 patients with adenomyosis treated by HIFU in The First People’s Hospital of Chenzhou from February 2018 to April 2019 were analyzed, and they were divided into diffuse adenomyosis group(group D,97 cases) and localized adenomyosis group(F group, 39 cases).According to the different treatments received after HIFU,the two groups of patients were divided into 4 groups, D1/F1 group: pure HIFU treatment group, D2/F2 group: HIFU+GnRH-a treatment group, D3/F3 group: HIFU+LNG-IUS treatment group, D4/F4 group: HIFU+GnRH-a+LNG-IUS treatment group, the postoperative ablation rate and the improvement of dysmenorrhea and menstrual flow were observed after 3,6 and 12 months.Results All 136 patients successfully completed HIFU treatment.The irradiation time and volume of the non-perfusion area in group D and group F were:(505.53±261.21)s,(60.16±48.61) cm^(3),(520.80±262.74)s,(51.35±40.67) cm^(3),and there was no statistical difference(P>0.05).The ablation rates of group D and group F were(71.71±22.84)% and(83.68±20.80)%,respectively, and the difference was statistically significant(P<0.05).At 3,6,and 12 months after operation, the effective rates of dysmenorrhea symptom improvement in group D were 92.3%,88.7% and 79.4% respectively, and those in group F were 97.4%,92.3% and 94.9%.There was no significant difference in the improvement of menstrual dysmenorrhea in group D and F(P>0.05).The effective rate of dysmenorrhea improvement in group F was better than that in group D at 12 months after operation(P<0.05).Menstrual improvement at 3,6,and 12 months after operation: group D was 88.7%,86.6%,82.5%,group F was 92.3%,92.3%,87.2%;group D and group F had menstrual flow at the same period after operation, the difference in improvement was not statistical

关 键 词：子宫腺肌病 高强度聚焦超声 痛经 促性腺激素释放激素激动剂 左炔诺孕酮宫内缓释系统 

分 类 号：R711.74[医药卫生—妇产科学]