高强度聚焦超声消融与手术切除治疗腹壁子宫内膜异位症的疗效对比研究  

The Efficacy Comparison of High-Intensity Focused Ultrasound Ablation and Surgical Excision in the Treatment of Abdominal Wall Endometriosis

作　　者：汪沙[1] 段华[1] WANG Sha;DUAN Hua(Department of Minimally Invasive Gynecologic Center,Beijing Obstetrics and Gynecology Hospital,Capital Medical University,Beijing Maternal and Child Health Care Hospital,Beijing 100006,China)

机构地区：[1]首都医科大学附属北京妇产医院,北京妇幼保健院妇科微创中心,100006

出　　处：《国际妇产科学杂志》2023年第3期261-265,共5页Journal of International Obstetrics and Gynecology

基　　金：国家自然科学基金(81571412);首都医科大学附属北京妇产医院中青年学科骨干培养专项(FCYY201920)。

摘　　要：目的:探讨高强度聚焦超声(high-intensity focused ultrasound,HIFU)消融和手术切除治疗腹壁子宫内膜异位症(abdominal wall endometriosis,AWE)的效果。方法:回顾性分析2015年1月—2019年11月我院住院治疗的262例AWE的临床资料,按照治疗方式分为HIFU组(n=64)和手术组(n=198),比较2组手术时间、术中出血量、住院时间、术后病灶大小、疼痛程度、临床疗效和并发症发生情况等。结果:HIFU组中位手术时间[34.5(22.3,47.3)min]明显短于手术组[40.0(30.0,60.0)min],差异有统计学意义(Z=-3.112,P=0.002);HIFU组中位住院时间[2.0(2.0,3.0)d]明显短于手术组[7.0(6.0,8.3)d],差异有统计学意义(Z=-11.982,P=0.000)。HIFU组与手术组临床疗效比较差异无统计学意义(χ2=-1.207,P=0.227)。HIFU组治疗后1、3、6个月行超声随访,病灶消融率分别为(88.25±13.09)%、(92.33±9.18)%和(98.67±4.09)%,至术后第12个月,病灶消融率均为100.00%。治疗后1、3、6、12个月病灶体积与治疗前比较差异均有统计学意义(均P<0.05)。HIFU组患者术后3、6、12个月疼痛评分均低于手术组(均P<0.05)。2组患者术后不良反应发生率分别为6.25%(4/64)和3.54%(7/198),差异无统计学意义(χ2=0.340,P=0.560)。结论:HIFU消融治疗AWE效果与手术切除相当,但在缩短手术时间、减少住院时间以及减轻术后疼痛等方面优于手术切除,因此HIFU消融可成为供AWE患者选择的安全、有效的治疗方式之一。Objective:To compare the clinical effect of high-intensity focused ultrasound(HIFU)ablation and surgery in the treatment of abdominal wall endometriosis(AWE).Methods:The clinical data of 262 AWE patients hospitalized in Beijing Obstetrics and Gynecology Hospital,Capital Medical University from January 2015 to November 2019 were retrospectively analyzed.According to the treatment modality,the patients were divided into HIFU group(n=64)and surgery group(n=198),comparing the operation time,intraoperative bleeding,hospital stay,postoperative lesion size,pain level,clinical efficiency and complications.Results:The median operation time in the HIFU group was 34.5(22.3,47.3)min,which was significantly shorter than 40.0(30.0,60.0)min in the surgery group(Z=-3.112,P=0.002).The median hospital stay in the HIFU group was 2.0(2.0,3.0)days,which was shorter than 7.0(6.0,8.3)days in the surgery group(Z=-11.982,P=0.000).There was no significant difference in clinical efficiency between 2 groups(χ^(2)=-1.207,P=0.227).In the HIFU group,ultrasound follow-up was performed 1,3 and 6 months after treatment.The ablation rates were(88.25±13.09)%,(92.33±9.18)%,(98.67±4.09)%,respectively.By the 12th month after operation,the ablation rates were 100.00%.The volume of lesions before treatment was significantly different from that at 1,3,6 and 12 months after treatment(P<0.05).There was significant difference in the degree of periodic pain between the HIFU group and the surgery group at 3,6 and 12 months after treatment(P<0.05).The rate of adverse reactions was 6.25%(4/64)in the HIFU group and 3.54%(7/198)in the surgery group,and there was no statistically significant difference between 2 groups(χ2=0.340,P=0.560).Conclusions:HIFU ablation for AWE is comparable to surgical resection,but it is superior to surgical resection in terms of shortening procedure time,reducing hospital stay and alleviating postoperative pain,making HIFU ablation one of the safe and effective options available to AWE patients.

关 键 词：子宫内膜异位症 腹壁 高强聚焦超声消融 复发 疗效比较研究 腹壁子宫内膜异位症 

分 类 号：R713.4[医药卫生—妇产科学]