子宫腺肌病病变形态对超声消融耐受性及安全性的影响

Analysis of risk-related factors of tolerance and complications on ultrasound ablation for the treatment of patients with adenomyosis.

目的评估子宫腺肌病病变形态对超声消融耐受性及常见并发症的影响,为合理选择适应证提供依据。方法选择重庆医科大学附属第一医院2010年1月至2012年12月接受镇静镇痛下超声消融治疗的子宫腺肌病患者237例,进行疼痛语言评价量表评分,监测治疗后副反应及并发症,分析子宫腺肌病病变形态、位置及大小与副反应及并发症的相关关系。结果 99.8%(236/237)的患者可以耐受超声消融治疗过程,95.8%的患者术中疼痛感觉为轻-中度,评分小于4分。副反应发生率为:下腹部疼痛87.3%;阴道血性分泌物27.4%;骶尾部、臀部痛10.5%;下肢麻木与疼痛5.1%;恶心、呕吐1.7%;乏力1.7%。并发症发生率4.2%(10/237),其中皮肤毒性发生率0.8%(2例),均为SIR-B级;神经毒性(下肢痛)发生率1.3%(3例)。腺肌病病变位于子宫后壁较前壁发生骶尾部、臀部痛的风险增加10.9倍;阴道血性分泌物发生的风险增加7.0倍;弥漫性病变较局限性病变发生下肢麻木及疼痛的风险增加8.6倍;后位子宫致骶尾部、臀部痛风险增加2.8倍;腺肌病病变大小与骶尾部痛、下腹痛、下肢麻木及疼痛、阴道血性分泌物的发生均相关。结论镇静镇痛下超声消融子宫腺肌病患者耐受性好、副反应轻、并发症少。病变的位置、形态、大小对安全性有一定影响,临床筛选病例及治疗时应予以考虑。

Objective To assess the tolerance and complications on ultrasound ablation for the treatment of patients with adenomyosis, and to analyze risk-related factors, aimed to provide the basis for eligible patients screening. Methods Between August 2009 and July 2012, a total of 237 patients received ultrasound ablation with sedalion for pure adenomyosis. The reaction during procedure was recorded. All patients were inquired about their pain levels during treatment using the Numerical Rating Scale immediately after the procedure. Complications after treatment were recorded. Results 99.8% （236/237） of patients tolerate procedure well, 95.8% （227/237） of patients had pain scores of no more than 4 points. Incidence of side effects as follows： there was 87.3% of lower abdominal pain; 27.4% of vaginal bloody dis- charge, and 10. 5% of the sacrococcygcal / buttock pain; 5. 1% of the lower extremity numbness or pain; 1.7% of nau- sea and vomiting and 1.7% of fatigue. Complication rate of 4. 2% as follows： there was two patients of 0. 8% experience skin toxicity, are SIR class B; neurotoxicity of 1.3% （3 patients）. Adenomyosis lesions located in the posterior wall than the anterior wall of the 10. 9 times increased risk occurred sacrococcygeal/buttock pain; bloody discharge occurred 7.0 times increased risk ; diffuse lesions than limitations lesions in the lower extremity numbness or pain of 8.6 times increased risk ; the posterior uterine caused sacrococcygeal / buttock pain 2.8 times increased risk ; adenomyosis lesion size and sacrococcygeal pain related, associated with lower abdominal pain, associated with numbness or pain, related to the occurrence of vaginal bloody discharge. Conclusion Ultrasound ablation appears to be a safe intervention for the treat- ment of adenomyosis, patients tolerated well, side effects of light, with few complications. Location, shape, size of the lesion has a certain influence on safety; which should be considered as clinical eligible patient screening and be treated.