聚焦超声消融手术在保留生育功能子宫腺肌病患者中的应用价值研究  

Application value of focused ultrasound ablation surgery in patients with adenomyosis who have a desire for future fertility

作　　者：马容 黄国华[2] 赵丹[2] 牟燕[2] 刘晓芳[2] 何佳[2] 张炼 MA Rong;HUANG Guo-hua;ZHAO Dan;MOU Yan;LIU Xiao-fang;HE Jia;ZHANG Lian(不详;Department of Gynecology of Chongqing Haifu Hospital,Chongqing 401121,China)

机构地区：[1]重庆海扶医院妇科,重庆401121 [2]遂宁市中心医院妇产科,四川遂宁629099 [3]超声医学工程国家重点实验室,重庆400016

出　　处：《中国实用妇科与产科杂志》2024年第9期937-942,共6页Chinese Journal of Practical Gynecology and Obstetrics

基　　金：超声医学工程国家重点实验室开放课题(2023KFKT002)。

摘　　要：目的 评价有生育要求的子宫腺肌病患者经聚焦超声消融手术(FUAS)治疗后的妊娠结局并分析影响妊娠结局的因素。方法 收集2010年10月至2023年10月在重庆海扶医院和遂宁市中心医院接受FUAS治疗的393例有生育要求的子宫腺肌病患者,FUAS后定期随访,记录患者的症状改善情况和生育相关信息。采用数字疼痛分级法(NRS)评价痛经程度,采用月经失血图(PBAC)评估月经量。根据是否妊娠将全部患者分为妊娠组及未妊娠组,妊娠组患者进一步分为成功分娩组及流产组,比较影响妊娠的相关指标。结果 (1)痛经症状改善情况:FUAS治疗后3个月,全部患者NRS评分中位数从7.0(4.0,8.0)分下降到3.0(2.0,5.0)分(P<0.05)。(2)月经量改变情况:全部患者PBAC评分中位数从135(105,135)分下降至105(55,105)分(P<0.05)。(3)治疗后妊娠情况:在随访(69.4±22.2)(11.0~144.0)个月后,170例患者妊娠199次,妊娠率为43.3%(170/393),其中自然受孕129例,体外受精-胚胎移植(IVF-ET)41例。在179例不孕症患者中,FUAS治疗后58例(32.4%)成功妊娠。logistic回归分析显示,盆腔粘连及不孕史是影响子宫腺肌病患者妊娠的独立危险因素(OR<1,P<0.05);子宫腺肌病病灶体积越大,妊娠的可能性越小(OR<1,P<0.05)。妊娠和分娩期间未发生子宫破裂。(4)流产组患者的子宫体积、子宫腺肌病病灶体积和消融体积均显著大于成功分娩组(P<0.05)。结论 FUAS治疗可显著改善子宫腺肌病患者的症状,对子宫腺肌病患者的生育能力有积极的影响。Objective To evaluate the pregnancy outcomes of patients with adenomyosis treated with focused ultrasound ablation surgery(FUAS)and analyze the influencing factors of pregnancy outcomes.Methods Totally 393 patients with adenomyosis who had a desire for future fertility completed FUAS at Chongqing Haifu Hospital and Suining Central Hospital of Sichuan from October 2010 to October 2023.These patients were included in the study and were followed up regularly after FUAS to record the improvement of symptoms and related reproductive information.The numeric rating scale(NRS)was used to evaluate dysmenorrhea,and the pictorial blood loss assessment chart(PBAC)was used to assess the menstruation volume.The patients were divided into pregnancy group and no-pregnancy group,and the pregnancy group was again divided into successful delivery group and abortion group.The related indicators influencing pregnancy were compared.Results(1) Improvement in symptoms of dysmenorrhea:The NRS score in all patients was significantly decreased from 7.0(4.0,8.0) to 3.0(2.0,5.0)points at 3 months after FUAS(P<0.05).(2) Improvement in menstruation:The PBAC score in all patients was also significantly decreased from 135(105,135)to 105(55,105)at 3 months after FUAS(P<0.05).(3) Pregnancy after treatment:After a follow-up of(69.4±22.2)(range:11.0-144.0) months,199 pregnancies in 170 patients were observed,and the pregnancy rate was 43.3%(170/393).Among them,129 patients conceived naturally and 41 conceived by in vitro fertilization embryo transfer(IVF-ET).Of the179 infertile patients,58(32.4%) we re pregnant after FUAS.Multiple logistic regression analysis showed that pelvic adhesion and infertility history were independent risk factors for pregnancy in patients with adenomyosis(OR<1,P<0.05).The larger the adenomyotic lesion volume,the less possibility the pregnancy(OR<1,P<0.05).No uterine rupture occurred during pregnancy or delivery.(4)The uterine volume,the adenomyotic lesion volume and the ablation volume in the abortion group were significa

关 键 词：聚焦超声消融手术 子宫腺肌病 不孕 体外受精-胚胎移植 

分 类 号：R711.6[医药卫生—妇产科学]