摘要
目的探讨高强度聚焦超声(HIFU)联合促性腺激素释放激素激动剂(GnRH-a)治疗子宫腺肌症的临床疗效并分析患者年龄和病程对其疗效的影响。方法选取确诊为子宫腺肌症的患者61例,均以痛经为主要症状且有生育要求,其中31例为实验组行HIFU联合GnRH-a治疗,30例为对照组行单纯HIFU治疗,评价两组患者术后6、12个月时的症状改善情况及总复发率,对比研究术后1、6、12个月的痛经评分、月经量评分、子宫体积缩小率、糖类抗原125(CA125)值的变化。将实验组以年龄>38岁与≤38岁及病程>4年与≤4年分别分为两组,比较两组的痛经及月经量评分下降程度、子宫体积缩小率。结果实验组术后6个月痛经及月经改善总有效率分别为96.77%及92.86%,术后12个月分别为89.29%及92.31%,均明显高于对照组,总复发率7.14%,明显低于对照组,复发时间亦较其延迟。两组间术后6个月和12个月,实验组痛经评分、月经量评分、CA125水平均明显低于对照组,子宫体积缩小率明显高于对照组,差异有统计学意义(P<0.05)。实验组年龄>38岁患者痛经评分下降及子宫体积缩小程度高于年龄≤38岁患者,病程>4年患者痛经及月经量评分下降程度高于病程≤4年患者,差异有统计学意义(P<0.05)。结论联合GnRH-a治疗较单纯HIFU治疗疗效更确切,可减少复发率,延迟复发,且更适用于年龄较大、病程较长的子宫腺肌症患者。
Objective To evaluate the clinical efficacy and safety of high intensity focused ultrasound（ HIFU）combined with GnRH-a in the treatment of adenomyosis and to analyze the influence of patient＇s age and course on clinical results. Methods 61 patients with adenomyosis were selected,and the principal symptom of the 61 patients was dysmenorrhea and fertility requirements. 31 cases who were treated with HIFU combined with GnRH-a were experience group,and 30 cases who were only treated with HIFU were control group,and to evaluate the improvement of symptoms and the total recurrence rate at 6,12 months after operation. Dysmenorrhea scores,menstrual blood volume,reduction rate of uterus size and CA125 value of the 1,6 and 12 months after operation was compared in 2 groups. The experience group was divided into 2 subgroups by（ age 38 or ≤38） and（ course 4 or ≤4）,To compare dysmenorrhea scores and menstrual volume decline,reduction rate of uterus size in the two subgroups. Results The total effective rate of dysmenorrhea and menstrual improvement in the experimental group was 96. 77% and 92. 86% respectively,12 months after operation were 89. 29% and 92. 31% respectively,which were significantly higher than the control group. The recurrence rate of the experimental group was 7. 14%,which was significantly lower than that of control group,and the recurrence time of the experimental group was delayed.At 6,12 months after operation,the menstrual blood volume,reduction rate of uterus size and CA125 value of the experimental group was lower than those of the control group. The rate of uterus volume reduction was higher than the control group,and the difference was statistically significant（ P〈0. 05）. Scores were decreased and uterine size were significantly higher in the experimental subgroups（ age 38） dysmenorrhea than the experimental subgroups（ age≤38）. Hypermenorrhea scores and menstrual volume decline in the experimental subgroup（ course 4）were significantly higher than the experimental subgroups（ course ≤4）,the difference was statistically significant（P〈0. 05）. Conclusion HIFU combined with GnRH-a treatment is preferable to HIFU treatment,which can reduce the recurrence rate,delays the recurrence,and is more suitable for older,longer course patients with adenomyosis.
出处
《安徽医科大学学报》
CAS
北大核心
2017年第12期1839-1844,共6页
Acta Universitatis Medicinalis Anhui
基金
安徽省公益性研究联动计划项目(编号:1604f0804010)
关键词
子宫腺肌症
高强度聚焦超声
促性腺激素释放激素
adenomyosis
high intensity focused ultrasound
gonadotropin releasing hormone antagonist
