聚焦超声联合热球子宫内膜消融术在治疗子宫腺肌病相关异常子宫出血中的临床疗效分析  

Analysis on clinical efficacy of HIFU combined with TBEA in treating adenomyosis-related abnormal uterine bleeding

作　　者：王泯蓉 张勇 沈娟[1] 何莉 Wang Minrong;Zhang Yong;Shen Juan;He Li(Department of Obstetrics and Gynecology,Mianyang Hospital Affiliated to School of Medicine of University of Electronic Science and Technology of China,Mianyang Central Hospital,Mianyang 621000,China;Department of Biomedical engineering,State Key Laboratory of Ultrasound in Medicine and Engineering of Chongqing Medical University,Chongqing 400016,China;Department of Obstetrics and Gynecology,Beichuan Qiang Autonomous County People's Hospital,Beichuan 622750,China)

机构地区：[1]电子科技大学医学院附属绵阳医院·绵阳市中心医院妇产科,绵阳621000 [2]重庆医科大学超声医学工程国家重点实验室生物医学工程学院,重庆400016 [3]北川羌族自治县人民医院妇产科,北川622750

出　　处：《中国医学装备》2024年第7期96-101,共6页China Medical Equipment

基　　金：重庆超声医学工程国家重点实验室开放课题资助(2020KFKT017)。

摘　　要：目的:探讨高强度聚焦超声(HIFU)消融治疗联合热球子宫内膜消融术(TBEA)治疗子宫腺肌病引起的异常子宫出血(AUB)的临床效果。方法:选取2021年2月至2022年10月于绵阳市中心医院就诊AUB的200例子宫腺肌病患者,按照治疗方法的不同将其分为观察组和对照组,每组100例。观察组采用HIFU联合TBEA治疗;对照组采用单独HIFU消融治疗。比较两组临床治疗效果、痛经症状、子宫体积的变化及血红蛋白水平的改善,以及月经量评分和痛经评分,观察两组治疗后不良反应。结果:治疗后,观察组月经过多症状明显好于对照组,观察组治疗总有效率达100%,对照组为70%,两组治疗总有效率比较差异有统计学意义(χ^(2)=35.29,P<0.05);治疗后痛经症状的临床有效率观察组高于对照组,观察组治疗总有效率达89%,对照组为77%,两组比较差异有统计学意义(χ^(2)=5.103,P<0.05)。与治疗前相比,两组治疗后1、3、6、12个月时月经量评分均降低,且观察组低于对照组,观察组治疗后各时间点月经量评分分别为1(1,1)分、1(1,1)分、1(1,1)分和1(1,1)分;对照组治疗后各时间点月经量评分分别为3(2,4)分、3(2,4)分、2(2,4)分和2(1,4)分,两组相比较差异有统计学意义(Z=-9.98、-9.424、-9.535、-4.224,P<0.05);两组各时间点血红蛋白比较,差异也均有统计学意义(Z=-6.66、-11.797、-12.22、3.338,P<0.05);两组子宫体积比较,6、12个月时差异有统计学意义(Z=-2.638、-2.679,P<0.05)。两组治疗后1、3、6、12个月时痛经评分,差异无统计学意义(P>0.05)。结论:HIFU联合TBEA治疗子宫腺肌病安全、有效,与单独HIFU消融治疗相比能显著减少月经量,提高子宫腺肌病所导致的异常子宫出血的疗效,能更有效的缩小子宫体积,促进血红蛋白上升;治疗后两组痛经评分下降程度差异无统计学意义,但观察组治愈率及有效率更高。Objective:To investigate the clinical effect of high-intensity focused ultrasound(HIFU)combined with thermal balloon endometrial ablation(TBEA)in treating abnormal uterine bleeding caused by adenomyosis.Methods:According to the treatment method of patients,a total of 200 patients with abnormal uterine bleeding due to adenomyosis(AUB-A),who admitted to Mianyang Central Hospital from February 2021 to October 2022,were divided into observation group and control group,with 100 cases in each group.Observation group adopted HIFU combined with TBEA to conduct treatment.The control group adopted HIFU ablation therapy alone.The clinical effects,dysmenorrhea symptom,changes of uterine volume and improvements of hemoglobin levels were compared between the two groups.Adverse reactions of them were also observed.Results:After treatment,the menorrhagia symptom of observation group was obviously better than that of control group,and the total effective rate of observation group was 100%,which was significantly higher than 70%of control group,and the difference was statistically significant(χ^(2)=35.29,P<0.05).After treatment,the clinically effective rate of the menorrhagia symptom of observation group was higher than that of control group,and the totally effective rate of observation group was 89%,which was significantly higher than 77%of control group,and the difference of that between the two groups was statistically significant(χ^(2)=5.103,P<0.05).Compared with the scores of menstrual volume before treatment,these decreased at 1,3,6 and 12 months after treatment,and scores of observation group were lower than these of control group.The scores of menstrual volumes of observation group at each time point after treatment were as follows:1(1,1)points,1(1,1)points,1(1,1)points and 1(1,1)points.The scores of menstrual volumes of the control group at each time point after treatment were as follows:3(2,4)points,3(2,4)points,2(2,4)points and 2(1,4)points,and the differences between the two groups were statistically significant(Z=-9

关 键 词：子宫腺肌病 高强度聚焦超声(HIFU) 热球子宫内膜消融术(TBEA) 异常子宫出血(AUB) 

分 类 号：R445.1[医药卫生—影像医学与核医学]