高强度聚焦超声治疗子宫腺肌病3种方案的疗效对比研究

目的对比分析单纯高强度聚焦超声(high intensity focused ultrasound,HIFU)治疗、HIFU治疗联合左炔诺孕酮宫内缓释系统(levonorgestrel-releasing intrauterine system,LNG-IUS)和HIFU治疗联合促性腺激素释放激素激动剂(gonadotropin-releasing hormone agonist,GnRH-a)3种方案治疗子宫腺肌病的临床疗效。方法选取2013年1月至2015年1月78例因子宫腺肌病就诊于石家庄市第一医院需要治疗的患者,经术前评估及患者知情同意后,根据患者意愿及手术适应证分为单纯HIFU治疗(45例),HIFU联合LNG-IUS治疗(15例)和HIFU联合GnRH-a治疗(18例),对比分析3组患者术后1月、6月、12月的痛经评分、经量等症状缓解程度、子宫及病灶体积大小变化。结果 3组患者治疗后痛经评分及月经量、子宫体积、病灶体积均较治疗前下降,差异有统计学意义(P0.05)。术后1月,3组间上述指标未见明显差异(P0.05);术后6月和12月两组患者的痛经评分和月经量明显低于单纯HIFU治疗组,子宫体积缩小率及病灶体积缩小率均高于单纯HIFU治疗组,差异有统计学意义(P0.05)。结论 3种方案治疗子宫腺肌病均安全有效;术后辅助LNG-IUS或GnRH-a治疗能更有效控制痛经及经量等临床症状,减小子宫及病灶体积,减少复发。

A comparative study of the clinical results of three schemes of high intensity focused ultrasound in the treatment of adenomyosis

Objective To compare the clinical results of treatment of adenomyosis by high intensity focused ultrasound( HIFU) or combined with levonorgestrel-releasing intrauterine system( LNG-IUS) or with gonadotropin-releasing hormone agonist( GnRH-a) . Methods Selected 78 patients with adenomyosis who treated in the First Hospital of Shijiazhuang from January 2013 to January 2015. They were divided into group HIFU(45 cases),group HIFU combined with LNG-IUS (15 cases) and group HIFU combined with GnRH-a(18 cases) by preoperative evaluation and patients' informed consent. Follow-up were maintained in all cases at 1,6 and 12 months after treatment. The clinical results of three groups were enrolled with visual analogue scale score( VAS) dysmenorrhea score, menstrual blood volume, uterine volume and tumor volume. Results After treatment all index including dysmenorrhea score, menstrual blood volume, uterine volume and tumor volume of three groups were decreased, the differences were statistically significant (P <0. 05). The observed index of the HIFU group did not differ significantly from HIFU with LNG-IUS group or HIFU with GnRH-a group at 1 month post-operation. And 6 or 12 months post-operation, all index decreased significantly greater in the last two groups than the HIFU group (P<0. 05). Conclusion HIFU can be effective in the treatment of adenomyosis. Combining with LNG-IUS or GnRH-a, HIFU can provide a superior and more comprehensive clinical effects on dysmenorrheal and hypermenorrhea than HIFU therapy alone.