不同治疗方案对子宫平滑肌瘤疗效评估相关研究

Assessment of curative effect of different treatment regimens for uterine myoma

目的子宫平滑肌瘤是一种常见的女性良性肿瘤，在育龄期女性中具有高发的特点，许多女性可在体检时候发现并无明显临床症状，随着女性对生活质量要求的不断提高及医疗技术的不断进步，手术治疗已不再是子宫平滑肌瘤的唯一治疗方案，故探讨不同方案治疗子宫肌壁间平滑肌瘤的疗效越来越重要，子宫肌瘤生长位置可多样性，故我们通过研究以探讨更适合不同子宫肌瘤患者的治疗方案，以为临床提供更适合的个性化治疗依据。方法回顾2008～2013年就诊于新疆维吾尔自治区人民医院B超证实为子宫肌壁间平滑肌瘤需行相关治疗的患者170例，其中行子宫动脉栓塞术30例，经腹或腹腔镜下子宫肌瘤剔除术90例，高强度超声聚焦治疗50例，通过术前妇科B超及磁共振检查筛选出相对适合上述治疗方案的患者，治疗后再次通过B超及磁共振检查判定肌瘤体积的变化，以判断治疗效果，比较3组治疗方案对子宫平滑肌瘤治疗后的效果。结果通过测定治疗前后子宫肌瘤体积变化，计算3种方法在治疗子宫平滑肌瘤的总有效率，分别为46．7％、94．4％、86．0％，子宫动脉栓塞组与手术及高强度超声聚焦治疗组间的差异均有统计学意义（P〈0．05），手术组及高强度超声聚焦治疗组的差异无统计学意义（P〉0．05）。结论子宫平滑肌瘤手术及高强度超声聚焦治疗优于子宫动脉栓塞，但在适应症方面高强度超声聚焦治疗具有一定的局限性。

Objective To assess the curative effect of different treatment regimens and provide personalized therapy for leiomyoma of uterus. Methods The clinical data of 170 cases of intramural uterine myoma confirmed by ultrasound examination in our hospital between 2008 and 2013 were reviewed. The preoperative ultrasound or MRI was used to assess the conditions of patients and select the regimen. 30 patients received uterine artery embolization（UAE） ,90 patients received transabdominal or laparoscopic hysteromyomectomy, and 50 patients received high intensity focused ultrasound. The curative effects were evaluated by ultrasound and MRI at the end of the treatment. Results The effectiveness of UAE, laparoscopic hysteromyomectomy and high intensity focused ultrasound were 46.7%, 94.4% and 86.0%, respectively, the difference between UAE group and laparoscopic hysteromyomectomy group or high intensity focused ultrasound group was statistical significant（P 〈0.05） ,but not significant between laparoscopic hysteromyomectomy group or high intensity focused ultrasound group （P 〉 0.05）. Conclusion The curative of hysteromyomectomy and high intensity focused ultrasound is superior to UAE in the treatment of leiomyoma of uterus, but the high intensity focused ultrasound had certain limitations.