高强度聚焦超声联合热球子宫内膜消融治疗子宫腺肌病相关月经过多的临床研究  

Clinical Study of High-Intensity Focused Ultrasound Combined with Endometrial Thermal Balloon Ablation for the Treatment of Menorrhagia Associated with Adenomyosis

作　　者：王丹 金卓婷[1,3] 王李纲 葛佳 张勇 WANG Dan;JIN Zhuoting;WANG Ligang(Department of Obstetrics and Gynecology,Mianyang Central Hospital,Mianyang Hospital Affiliated to School of Medicine,University of Electronic Science and Technology of China,Mianyang Sichuan 621000,China;State Key Laboratory of Ultrasound in Medicine and Engineering,Chongqing Medical University,Chongqing 400016,China;Department of Obstetrics and Gynecology,Affiliated Hospital of Southwest Medical University,Luzhou Sichuan 646000,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,四川绵阳621000 [2]重庆医科大学超声医学工程国家重点实验室,重庆400016 [3]西南医科大学附属医院妇产科,四川泸州646000

出　　处：《实用妇产科杂志》2024年第7期560-565,共6页Journal of Practical Obstetrics and Gynecology

基　　金：超声医学工程国家重点实验室开放课题(编号:2020KFKT017);绵阳市卫生健康委员会科研项目(编号:202020)。

摘　　要：目的:探讨高强度聚焦超声(HIFU)联合热球子宫内膜消融(TBEA)治疗子宫腺肌病(AM)相关月经过多的疗效和安全性。方法:回顾性分析2021年1月至2022年12月在绵阳市中心医院就诊的AM合并月经过多患者77例的临床资料。根据不同的治疗方案分为HIFU联合TBEA组(HIFU+TBEA组,n=26)和HIFU联合促性腺激素释放激素激动剂(GnRH-a)及左炔诺孕酮宫内节育系统(LNG-IUS)(HIFU+药物组,n=51)。以HIFU治疗后不同随访时间点月经失血图(PBAC)评分作为主要结局指标,以痛经数字评定量表(NRS)评分、肿瘤糖类抗原125(CA 125)水平、再干预率、治疗有效率和不良反应情况作为次要结局指标。通过比较两组治疗前与治疗后不同时间结局指标的差异,评价HIFU联合TBEA治疗AM相关月经过多的疗效和安全性。结果:与治疗前比较,两组患者治疗后PBAC评分、NRS评分及CA 125均有显著下降(P<0.05)。与HIFU+药物组比较,HIFU+TBEA组治疗后6、9、12月PBAC评分更低(P<0.05),治疗后1、3月PBAC评分差异无统计学意义(P>0.05)。两组患者治疗后1、3、6、9、12月NRS评分差异无统计学意义(P>0.05)。HIFU+TBEA组(11.54%)和HIFU+药物组(21.57%)治疗后再干预率差异无统计学意义(P>0.05)。HIFU+TBEA组(80.77%)和HIFU+药物组(70.59%)治疗总有效率差异无统计学意义(P>0.05)。两组患者治疗后的不良反应国际介入放射治疗协会(SIR)分类均在A~B级,无严重不良事件发生。结论:HIFU联合TBEA治疗AM相关月经过多具有较好的疗效和安全性,可作为无生育需求尤其是合并月经过多AM患者的一种长期管理方案,具有较好的临床应用价值。Objective:To investigate the efficacy and safety of high intensity focused ultrasound(HIFU)combined with endometrial thermal Balloon ablation(TBEA)in the treatment of menorrhagia associated with adenomyosis(AM).Methods:A retrospective cohort study was performed on clinical data of 77 patients with menorrhagia associated with adenomyosis(AM)in Mianyang Central Hospital from January 2021 to December 2022.According to different treatment methods,they were divided into HIFU combined with TBEA(HIFU+TBEA group,n=26)and HIFU combined with gonadotropin-releasing hormone agonist(GnRH-a)and levonorgestrel-releasing intrauterine system(LNG-IUS)(HIFU+drug group,n=51).The pictorial blood loss assessment chart(PBAC)at different follow-up time after HIFU ablation was used as the main outcome index,dysmenorrhea score(NRS),serum CA 125 level,re intervention rate,treatment effectiveness rate and adverse reactions were used as the secondary outcome indexes.Evaluate the efficacy and safety of HIFU combined with TBEA in the treatment of menorrhagia associated with AMby comparing the difference of outcome indexes between two groups before and after treatment at different times.Results:Compared with pre-treatment,the PBAC score,NRS score and CA 125 level were significantly decreased after treatment in both groups(P<0.05).Compared with HIFU+drug group,PBAC score of HIFU+TBEA group decreased more at 6,9 and 12 months after treatment(P<0.05),but there was no significant difference in PBAC score at 1 and 3 months after treatment(P>0.05).There was no significant difference in NRS scores between the two groups at 1,3,6,9 and 12 months after treatment(P>0.05).There was no significant difference in reintervention rate between HIFU+TBEA group(11.54%)and HIFU+drug group(21.57%)after treatment(P>0.05).There was no significant difference in treatment effectiveness between HIFU+TBEA group(80.77%)and HIFU+drug group(70.59%)(P>0.05).The adverse reactions of the two groups after treatment were graded as SIR A-B,and no serious adverse events occurred.C

关 键 词：子宫腺肌病 高强度聚焦超声 热球子宫内膜消融 促性腺激素释放激素激动剂 左炔诺孕酮宫内节育系统 

分 类 号：R711.71[医药卫生—妇产科学]