摘要
目的探讨高强度聚焦超声(HIFU)、促性腺激素释放激素激动剂(GnRH-a)、左炔诺孕酮宫内缓释系统(LNG-IUS)单独或联合治疗子宫腺肌病(AM)的临床效果。方法回顾性分析2018年7月至2019年3月新疆医科大学第一附属医院接受保守治疗的338例AM患者的临床及随访资料,比较HIFU治疗(H组)、GnRH-a治疗(G组)、LNG-IUS治疗(L组)、HIFU联合GnRH-a治疗(H+G组)、HIFU联合LNG-IUS治疗(H+L组)、HIFU联合GnRH-a及LNG-IUS治疗(H+G+L组)组患者治疗后3、6、12个月的治疗相关参数、痛经(VAS)评分、月经量(PBAC)评分、子宫体积、痛经复发率、血红蛋白(Hb)和糖类抗原125(CA125)水平。结果4组采用了HIFU的患者治疗声功率、治疗时间、病灶消融率差异无统计学意义(P>0.05)。6组在治疗后3、6、12个月VAS评分、PBAC评分和CA125水平较治疗前均明显下降(P<0.05),H组、H+G组、H+L组、H+G+L组在治疗后Hb持续上升(P<0.05)。H+G组、H+L组及H+G+L组在治疗后3、6个月VAS评分均明显低于H组和L组(P<0.05);G组和H+G组在治疗后3个月痛经缓解达100%,后疗效下降;痛经复发率在H组、G组、L组、H+G组、H+L组、H+G+L组分别为19.44%、30.16%、26.67%、7.30%、8.10%、3.77%(P<0.05)。H+G组、H+L组及H+G+L组在治疗后6、12个月PBAC评分明显小于H组、L组和G组。L组治疗前子宫体积小于其他各组(P<0.05),在治疗后3、6、12个月子宫体积较治疗前轻度增加但差异无统计学意义(P>0.05)。在治疗后3个月G组、H+G组、H+G+L组子宫体积小于H和G组(P<0.05);G组在治疗后12个月子宫体积大于治疗后3、6个月,但仍小于治疗前。H+G+L组在治疗后12个月子宫体积、VAS评分、PBAC评分均小于其余各组(P<0.05)。结论HIFU、GnRH-a、LNG-IUS单独或联合治疗AM安全有效,但综合治疗能提高临床疗效,延缓并减少复发,降低子宫切除率。
Objective To investigate the clinical effects of high-intensity focused ultrasound(HIFU),gonadotropin-releasing hormone agonist(GnRH-a),and levonorgestrel intrauterine extended-release system(LNG-IUS)on adenomyosis(AM)alone or in combination.Methods The clinical and follow-up data of 338 AM patients who received conservative treatment in the First Affiliated Hospital of Xinjiang Medical University from July 2018 to March 2019 were analyzed retrospectively.The treatment related parameters,dysmenorrhea(VAS)score,menstrual volume(PBAC)score,uterine volume,recurrence rate of dysmenorrhea,hemoglobin(Hb)and carbohydrate antigen 125(CA125)levels at 3,6,and 12 months after treatment were compared among HIFU treatment(H group),GnRH-a treatment(G group),LNG-IUS treatment(L group),HIFU combined with GnRH-a treatment(H+G group),HIFU combined with LNG-IUS treatment(H+L group),HIFU combined with GnRH-a and LNG-IUS treatment(H+G+L group).Results There was no significant difference in sound power,treatment time and ablation rate among the four HIFU groups(P>0.05).The dysmenorrhea score,menstrual volume score,and CA125 levels in the 6 groups were significantly lower than before treatment(P<0.05).The hemoglobin level of H group,H+G group,H+L group,H+G+L group continued to increase after treatment(P<0.05).The VAS scores of the H+G,H+L,and H+G+L groups were significantly lower than those of the H and L groups at 3 and 6 months after treatment(P<0.05).G group and H+G group alleviated 100%of dysmenorrhea after 3 months of treatment,and the curative effect decreased afterwards.The recurrence rate of dysmenorrhea was 19.44%,30.16%,26.67%,7.30%,8.10%,3.77%in H group,G group,L group,H+G group,H+L group,and H+G+L group,respectively(P<0.05).The PBAC scores in the H+G,H+L,and H+G+L groups were significantly lower than those in the H,L,and G groups at 6 and 12 months after treatment(P<0.05).The uterus volum in group L before treatment was smaller than that of the other groups(P<0.05),and the uterus volume increased slightly in 3 months,6 months,and 12 months after treatment than before treatment,but with no statistically significant difference(P>0.05).The uterine volume of G,H+G,and H+G+L groups were smaller than that of H and G groups at 3 months after treatment,and the uterine volume of group G at 12 months after treatment was larger than that at 3 and 6 months after treatment,but still smaller than before treatment(P<0.05).The uterine volume,dysmenorrhea score,and menstrual volume score of the H+G+L group at 12 months after treatment were[(157.33±35.96)cm3,(1.07±0.82)point,(69.57±17.24)point],which were all smaller than those of the other groups(P<0.05).Conclusions HIFU,GnRH-a,LNG-IUS alone or combined treatment of AM are safe and effective,but comprehensive treatment can improve clinical efficacy,delay and reduce recurrence and reduce the incidence of total hysterectomy.
作者
毕晓迪
马俊旗
Bi Xiaodi;Ma Junqi(Department of Gynecology,the First Affiliated Hospital of Xinjiang Medical University,Urumqi 830000,China)
出处
《中国医师杂志》
CAS
2021年第5期663-667,673,共6页
Journal of Chinese Physician
基金
国家自然科学基金(81960463)。
关键词
超声
高强聚焦
促性腺素释放激素激动剂
左炔诺孕酮
子宫腺肌病
Ultrasound,high-intensity focused
Gonadotropin-releasing hormone agonist
Levonorgestrel
Adenomyosis
