HIFU治疗多发子宫肌瘤的疗效及对卵巢功能的影响

Curative efficacy of HIFU on multiple uterine fibroids and its effect on ovarian function

目的探讨高强度聚焦超声(HIFU)消融治疗多发子宫肌瘤的的临床效果,并观察对患者卵巢功能的影响。方法随机选取北京市怀柔区妇幼保健院和南京医科大学附属医院2012年1月至2013年6月治疗的子宫肌瘤患者83例,根据治疗方法随机分为对照组和观察组。对照组40例,应用子宫肌瘤剔除术治疗;观察组43例,应用HIFU消融治疗。主要评估指标为两组的临床治疗效果,HIFU术后患者3个月和6个月的月经状况、瘤体大小、卵泡生成激素(FSH)、雌二醇(E_2),并观察患者的不良反应。结果两组临床治疗效果比较差异无统计学意义(P>0.05)。观察组术后平均住院天数低于对照组(t=3.125,P<0。05)。观察组治疗后3个月的月经量、经期和瘤体大小均低于治疗前(t值分别为5.372、4.231、6.125,均P<0.05);治疗后6个月的月经量、经期和瘤体大小均低于治疗前和治疗后3个月(t值分别为6.124、3.876、5.584、4.125、7.124、4.153,均P<0.05)。观察组治疗后3个月FSH和LH水平均低于治疗前(t值分别为4.257、4.273,均P<0.05)。观察组治疗后6个月FSH和LH水平均低于治疗前和治疗后3个月(t值分别为7.142、4.334、5.135、3.376、均P<0.05)。观察组治疗后3个月E_2水平高于治疗前(t=4.126,P<0.05),且治疗后6个月水平均高于治疗前和治疗后3个月(t值分别为6.325、5.125,均P<0.05)。观察组患者主要不良反应为下腹疼痛18.60%(8/43),骶尾部、臀部疼痛6.98%(3/43),治疗区皮肤烫16.28%(7/43),盆腔积液4.65%(2/43),阴道排液6.98%(3/43)。结论 HIFU是一种较安全有效治疗子宫肌瘤的方法,患者卵巢功能恢复良好,并发症较少。

Objective To explore the clinical efficacy of high intensity focused ultrasound （ HIFU） ablation treatment on multiple uterine fibroids and observe its influence on ovarian function.Methods Eighty-three patients with uterine fibroids were randomly selected in Huairou District Child Health Hospital of Beijing and Nanjing Medical University Affiliated Hospital from January 2012 to June 2013. According to treatment methods, they were randomly divided into control group and observation group, 40 cases in the control group with application of myomectomy and 43 cases in the observation group with HIFU ablation therapy.The main evaluation indexes were clinical treatment effect, menstrual status, tumor size, follicle stimulating hormone （FSH） and estradiol （E2） levels three months and six months after HIFU, and adverse reactions.Results The clinical treatment effect was not significantly different between two groups （P〉0.05）. The average hospital stay of the observation group was shorter than the control group （t=3.125, P〈0.05）.In the observation group menstrual flow, menstruation and tumor size were less three months after treatment than those before treatment （ t value was 5.372, 4.231 and 6.125, respectively, all P〈0.05）.Six months after treatment, the amount of menstrual flow, menstruation and tumor size were less than those before treatment and those three months after treatment （ t value was 6.124, 3.876, 5.584, 4.125, 7.124 and 4.153, respectively, all P〈0.05）.Three months after treatment FSH and LH levels in the observation group were lower than before treatment （t value was 4.257 and 4.273, respectively, both P〈0.05）, and six months after treatment the levels were lower than those before treatment and three months after treatment （t value was 7.142, 4.334, 5.135 and 3.376, respectively, all P〈0.05）.E2 level in the observation group was higher three months after treatment than that before treatment （t=4.126, P〈0.05）, and after six months of treatment it was higher than that before treatment and three months after treatment （t value was 6.325 and 5.125, respectively, bothP〈0.05）.The main adverse reactions of patients in the observation group were abdominal pain （18.60%, 8/43）, sacrococcygeal and hip pain （6.98%, 3/43）, skin burns at treatment area （16.28%, 7/43）, pelvic effusion （4.65%, 2/43）, and vaginal discharge （6.98%, 3/43）. Conclusion HIFU is a relatively safe and effective method in the treatment of uterine fibroids, with good recovery of ovarian function and fewer complications.