子宫肌瘤超声消融治疗率的影响因素研究

Influential factors of high intensity focused ultrasound ablation for patients with uterine fibroid

目的:探讨影响推广应用子宫肌瘤高强度聚焦超声(high intensity focused ultrasound,HIFU)消融治疗的因素。方法:本研究数据资料来源于遂宁市中心医院妇产科,通过对2015年2月至2015年9月前往四川省遂宁市中心医院咨询的1121名子宫肌瘤患者的相关信息和影响因素进行分析,指导患者现场填写调查表格完成数据资料的收集,包括部分人口学相关信息、医院诊疗流程相关信息和子宫肌瘤患者症状程度等。统计学上采用多因素logistic回归分析和最大似然估计的向前逐步回归法(forward LR)对影响患者治疗选择的因素进行分析。结果:1 121位患者中最终进行HIFU治疗的患者399人,治疗比例为35.59%。多因素分析显示:医师本人是否推荐进行HIFU治疗(OR=4.519,95%CI=1.055~1.438,P=0.049)、医师对HIFU的介绍是否规范(OR=2.202,95%CI=1.009~20.243,P=0.000)、患者是否了解子宫肌瘤的各项治疗方式(OR=1.629,95%CI=1.539~3.153,P=0.006)、经济水平(OR=1.190,95%CI=1.044~1.356,P=0.009)、医保种类(保险报销幅度)(OR=1.356,95%CI=1.168~1.574,P=0.000)、症状程度(OR=1.232,95%CI=1.154~2.300,P=0.008)与患者是否选择HIFU治疗相关。结论:医师本人是否推荐进行HIFU治疗、医师对HIFU的介绍是否规范、患者是否了解子宫肌瘤的各项治疗方式、经济水平、医保种类(保险报销幅度)、症状程度是影响患者选择HIFU治疗的因素。参考以上因素的影响,有助于HIFU应用的推广。

Objective：To explore the influential factors of high intensity focused ultrasound for uterine fibroid. Methods：The data of this study came from the department of obstetrics and gynecology of Suining Central Hospital by instructing patients to fill out the form on site, including part of the demographic information, hospital treatment process related information and the degree of uterine fibroid symptoms. From February 2015 to September 2015,1121 patients with uterine fibroids in Suining Central Hospital were an- alyzed by multiple-factor logistic regression analysis （Forward LR）. Results： Totally 399 of 1121 patients （35.59%） were treated by high intensity focused ultrasound and the logistic regression analysis showed that six factors：doctor＇s recommendation of HIFU （ OR=4.519,95%CI= 1.055 to 1.438, P=0.049）, doctor＇ s standardized introduction of HIFU （ OR =2.202,95%CI= 1.009 to 20.243, P= 0.000）, understanding of various treatment modalities （OR = 1.629,95 % CI= 1.539 to 3.153, P=0.006）, financial status （OR = 1.190,95% CI=1.044 to f.356,P=0.009）,type of insurance（different reimbursement rates of insurance）（0R=1.356,95%C1=1.168 to 1.574,P= 0.000 ） i symptoms （ OR = 1.232,95 % CI= 1.154 to 2.300, P= 0. 008 ） were related with HIFU application. Conclusion： Doctor＇ s recommen-dation of HIFU,doctor＇s standardized introduction of HIFU, understanding of various treatment modalities,financial status, type of insurance （different reimbursement rate of insurance）, symptoms are the key factors that affecting clinical application of HIFU. Reference to the influence of these factors contributes to the promotion of HIFU application.