HIFU联合GnRHa治疗子宫腺肌病的疗效

Effect of HIFU combined with Gn RHa in the treatment of uterine gland disease

目的探究高强度聚合超声(HIFU)联合促性腺激素释放激素激动剂(Gn RHa)治疗子宫腺肌病(AM)的临床疗效。方法选取我院住院AM患者105例为临床资料,按照治疗策略不同随机分为Gn RHa组、HIFU组、联合治疗组三组各35例。Gn RHa组采用皮下组织注射Gn RHa方式治疗,HIFU组治疗采用高强度聚焦超声方法治疗,联合治疗组采用HIFU与Gn RHa联合应用的方式治疗。观察三组患者治疗后3个月、6个月、12个月的子宫体积、病灶大小、痛经评分、血清血红蛋白(Hb)四项指标变化。结果三组患者子宫体积随着治疗时间的推移均有明显缩小,联合治疗组体积缩小程度最迅速,在治疗后6个月、12个月时明显小于Gn RHa组和HIFU组(P<0.05)。三组患者病灶大小随着治疗时间的推移均有明显缩小,联合治疗组病灶缩小最多,在治疗后3个月、6个月、12个月时均明显小于Gn RHa组和HIFU组(P<0.05)。三组患者痛经评分随着治疗时间的推移均有明显改善,联合治疗组及HIFU组病灶缩小痛经评分下降最明显,在治疗12个月后明显小于Gn RHa组(P<0.05)。三组患者血清Hb水平随着治疗时间的推移均有明显升高,联合治疗组Hb水平上升程度最迅速,在12个月时明显高于Gn RHa组和HIFU组(P<0.05)。结论联合治疗方法治疗AM较单纯应用Gn RHa和HIFU治疗在缩小子宫体积、减小病灶大小、改善痛经情况及升高血清Hb水平等方面具有明显优势。

Objective To explore the clinical effect of high intensity polymerized ultrasound（HIFU） combined with gonadotropin releasing hormone agonist（Gn RHa） for treatment of adenomyosis（AM）. Methods 105 patients with AM in our hospital were randomly divided into Gn RHa group, HIFU group, and combined treatment group,35 each. The Gn RHa group was treated by subcutaneous tissue injection of Gn RHa, and the HIFU group was treated by HIFU, and the combined treatment group was treated by HIFU and Gn RHa. The three groups were observed for changes of four indicators ： uterine volume, lesion size, dysmenorrhea score and serum hemoglobin（Hb） at 3 months, 6 months and 12 months after treatment. Results The uterine volumes of the three groups were significantly reduced during the course of treatment; the reduction was more obvious and faster in the combined treatment group and HIFU group. The uterine volumes of combined treatment group at 6 months and 12 months after treatment were significantly lower than those in Gn RHa group and HIFU group（P 〈0.05）. The lesion sizes were significantly reduced in all three groups during the course of treatment; in the combined treatment group, the reduce of lesions after 3 months, 6 months and 12 months of treatment were significantly lower than those of Gn RHa combined HIFU group（P〈0.05）.The dysmenorrhea scores in all three groups were significantly improved; the dysmenorrhea score of the combined treatment group and HIFU lesions decreased more rapid, and at 12 months after treatment were significantly lower than that in Gn RHa group（P〈0.05）The serum Hb levels of all three groups were significantly increased during treatment; the Hb level of combined treatment group was increased more rapid, and was significantly higher than those of Gn RHa combined HIFU group at 12 months after treatment（P〈0.05）. Conclusion The treatment of HIFU combined with Gn RHa was obviously superior than only use HIFU or Gn RHa in the treatment of AM. It could reduce uterine volume and the size of the lesion, alleviate dysmenorrhea, and increase serum Hb level.