高强度聚焦超声联合米非司酮治疗子宫腺肌症效果研究

Effect of Noninvasive High Intensity Focused Ultrasound Combined with Mifepristone in Treatment of Patients with Adenomyosis

目的探讨高强度聚焦超声(high intensity focused ultrasound,HIFU)无创疗法联合米非司酮治疗子宫腺肌症的效果。方法选取2015年10月—2017年1月因子宫腺肌症行HIFU治疗的患者110例。根据治疗方法分为观察组和对照组,每组55例。对照组单纯采用HIFU治疗,观察组在对照组基础上加用米非司酮治疗。观察并比较两组的子宫体积变化、临床疗效、临床症状改善及不良反应情况。结果两组治疗后6个月子宫体积均小于治疗前(P<0.05)。两组在治疗后1个月、3个月、6个月时病灶体积均小于治疗前(P<0.05);在相同时间点两组病灶体积、病灶消融率比较差异均无统计学意义(P>0.05)。治疗后12个月,两组月经量均少于治疗前(P<0.05),观察组月经量少于对照组(P<0.05)。治疗后12个月,观察组痛经程度较治疗前明显改善(P<0.05)。观察组临床疗效总有效率高于对照组(P<0.05)。两组不良反应总发生率比较差异无统计学意义(P>0.05)。结论单纯HIFU无创疗法或HIFU联合米非司酮治疗子宫腺肌症安全有效,均能有效缩小病灶体积,改善临床症状,但后者疗效果更佳。

Objective To investigate effect of noninvasive high intensity focused ultrasound （HIFU） combined with Mifepristone in treatment of patients with adenomyosis. Methods A total of 110 patients with adenomyosis undergo- ing HIFU during October 2015 and January 2017 were selected, and the patients were divided into observation group （n=55） and control group （n=55） according to therapeutic methods. Control group was treated with HIFU alone, while observation group was added with Mifepristone on the basis of treatment for control group. Changes of uterine vol- ume, clinical efficacy, improvement conditions of clinical symptoms and adverse reactions were observed and Compared between the two groups. Results In the two groups, after treatment for 6 months, values of uterine volume were less than those before treatment （P 〈 0.05） ; after treatment for 1 month, 3 months and 6 months, values of lesion volume were less than those before treatment （ P 〈 0.05）. There were no significant differences in lesion volume and ablation rate at the same time point between the two groups （P 〉 0.05）. After treatment for 12 months, values of menstrual volume were less than those before treatment in two groups （P 〈 0.05） ; value of menstrual volume in observation group was less than that in control group after treatment for 12 months than that before treatment （P 〈 0.05） ; the dysmenorrhea degree in observation group was significantly improved （P 〈 0. 05）. The total effective rate in observation group was significantly higher than that in control group （P 〈 0.05）. There was no significant difference in total incidence rate of adverse reac- tions between the two groups （P 〉 0. 05）. Conclusion Both noninvasive HIFU therapy and HIFU combined with Mife- pristone in treatment of patients with adenomyosis can effectively decrease lesion volume and improve clinical symptoms, but HIFU combined with Mifepristone can achieve better effect.