HIFU与手术治疗腹壁子宫内膜异位症的疗效比较

Comparison of the Effect of HIFU and Surgery in the Treatment of Abdominal Wall Endometriosis

目的观察高强度聚焦超声(HIFU)与手术切除治疗腹壁子宫内膜异位症(AWE)的疗效,探讨AWE微创有效的治疗方法。方法收集2016年6月~2019年6月就诊于我院的AWE患者59例,根据治疗方式不同分为HIFU组(n=29)和手术组(n=30),分析HIFU治疗情况,比较两组手术时间、术中出血量、术中伤及肌肉层、住院总天数、术后住院天数、手术前后病灶直径变化、疼痛视觉模拟评分(VAS)、药物干预率、并发症及复发情况。结果HIFU组29例患者均顺利完成治疗,消融辐照总时间为(453.04±191.03)s,治疗功率为(116.79±61.51)W,治疗总能量为(50831.79±25861.18)J。治疗后有27例患者(93.10%)出现团块状灰度变化,2例患者出现整体灰度变化。HIFU消融术中无出血量及肌肉层损伤,与手术组比较,差异有统计学意义(P<0.05);HIFU组手术时间长于手术组,住院总天数及术后住院时间均短于手术组(P<0.05),治疗后两组VAS评分较治疗前降低(P<0.05),但组间比较,差异无统计学意义(P>0.05);HIFU组术后6个月的病灶直径为(5.15±6.38)mm,大于手术组的0(P<0.05);HIFU组术后6个月病灶直径较术前缩小77.61%,其中3例患者病灶完全消失;HIFU组并发症总发生率、药物干预率均低于手术组(P<0.05);HIFU组复发率为0,低于手术组的3.33%,但差异无统计学意义(P>0.05)。结论与手术切除相比,HIFU治疗腹壁子宫内膜异位症微创、有效、恢复时间短、并发症少,值得应用。

Objective To observe the efficacy of high-intensity focused ultrasound(HIFU)and surgical resection in the treatment of abdominal wall endometriosis(AWE),and explore the minimally invasive and effective treatment methods of AWE.Methods A total of 59 AWE patients treated in our hospital from June 2016 to June 2019 were collected and divided into HIFU group(n=29)and surgery group(n=30)according to different treatment methods.The treatment of HIFU was analyzed and the operation time,intraoperative blood loss,intraoperative injury and muscle layer,total length of hospital stay,postoperative length of hospital stay,changes of lesion diameter before and after operation,visual analogue scale(VAS),drug intervention rate,complications and recurrence were compared between the two groups.Results In HIFU group,the total time of ablation was(453.04±191.03)s,the power was(116.79±61.51)W,and the total energy was(50831.79±25861.18)J.After treatment,27 patients(93.10%)had massive gray changes,and 2 patients had overall gray changes.There was no blood loss and muscle layer injury during HIFU ablation,and the difference was statistically significant compared with the operation group(P<0.05);the operation time of HIFU group was longer,the total hospital stay and postoperative hospital stay of the operation group were shorter than those of the operation group(P<0.05),After treatment,the VAS scores of the two groups were lower than before treatment(P<0.05).However,there was no significant difference between the two groups after treatment(P>0.05);The diameter of the lesion in the HIFU group at 6 months after operation was(5.15±6.38)mm,which was larger than 0 in the operation group(P<0.05);The average diameter of the lesions in the HIFU group was reduced by 77.61%compared with the preoperative 6 months after the operation,and the lesions disappeared completely in 3 patients;the total incidence of complications and drug intervention rate in the HIFU group was lower than surgery group(P<0.05);The recurrence rate in the HIFU group was 0,which was lower than 3.33%in the surgery group,but the difference was not statistically significant(P>0.05).Conclusion Compared with surgical resection,HIFU treatment of abdominal wall endometriosis is minimally invasive,effective,has a shorter recovery time and fewer complications,and is worthy of application.