高强度聚焦超声子宫肌瘤消融术对子宫内膜容受性、性激素水平及妊娠结局的影响

Effect of high-intensity focused ultrasound ablation of uterine fibroids on the endometrial receptivity,sex hormone levels and pregnancy outcomes in patients with uterine fibroids

目的探讨高强度聚焦超声(HIFU)子宫肌瘤消融术对子宫肌瘤病人子宫内膜容受性、性激素水平及妊娠结局的影响。方法选取2013年6月至2015年8月中国人民解放军联勤保障部队第九八八医院收治的有生育要求的80例子宫肌瘤病人根据病人自愿选择的治疗方式分为HIFU组(n=48)、对照组(n=32),分别行HIFU子宫肌瘤消融术和腹腔镜(或宫腔镜)子宫肌瘤切除术治疗。比较两组子宫内膜容受性、性激素水平及妊娠结局。结果两组术前子宫内膜容受性、性激素水平比较,差异无统计学意义(P>0.05),术后3个月子宫内膜容受性均明显改善,但HIFU组子宫内膜厚度,内膜容积,内膜与内膜下血管化指数(VI)、血流指数(FI,0～100)、血管化血流指数(VFI,0～100)增加或升高幅度明显大于对照组,差异有统计学意义(P<0.05);与术前相比,对照组术后3个月促卵泡生长激素(FSH)、促黄体生长素(LH)水平显著升高(P<0.05),而HIFU组与术前相比差异无统计学意义(P>0.05),且HIFU组术后3个月FSH、LH、雌二醇(E2)水平明显低于对照组(P<0.05)。HIFU组术后个月内有23例妊娠,对照组有8例妊娠,比较其妊娠结局,发现HIFU组妊娠者剖宫产率为26.09%,明显低于对照组的62.50%,差异有统计学意义(P<0.05),两组妊娠后胚胎停育、人工流产率比较差异无统计学意义(P>0.05)。结论 HIFU子宫肌瘤消融术可有效改善子宫肌瘤病人子宫内膜容受性,对性激素水平影响小,并对妊娠和生育结局的改善有积极作用。

Objective To investigate the effect of high-intensity focused ultrasound(HIFU)ablation of uterine fibroids on the endometrial receptivity,sex hormone levels and pregnancy outcomes in patients with uterine fibroids.Methods 80 patients with uterine fibroids and fertility requirements who were admitted to the 988 Hospital of the Joint Logistics Support Force of the Chinese People’s Liberation Army from June 2013 to August 2015 were divided into HIFU group(n=48)and control group(n=32)according to the treatment chosen by patients voluntarily.The two groups were treated with HIFU ablation of uterine fibroids,laparoscopic or hysteroscopic hysteromyomectomy,respectively.The endometrial receptivity,sex hormone levels and pregnancy outcomes were compared between the two groups.Results There was no significant difference between the two groups in the endometrial receptivity or sex hormone levels before operation(P>0.05).Three months after operation,the endometrial receptivity was significantly improved.Changes of the endometrial thickness,endometrial volume,endometrial and sub-endometrial vascularization index(Ⅵ),flow index(FI,0~100)and vascularization flow index(VFI,0~100)in HIFU group were significantly greater than those in the control group(P<0.05).Levels of follicle stimulating hormone(FSH)and luteinizing hormone(LH)in the control group were significantly increased at 3 months after operation(P<0.05),while there was no statistical significance in HIFU group(P>0.05).The levels of FSH,LH and estradiol(E2)in HIFU group at 3 months after operation were significantly lower than those in the control group(P<0.05).There were 23 and 8 pregnant cases in HIFU group and the control group within 18 months after operation.Comparison of pregnancy outcomes found that the cesarean section rate of HIFU group was significantly lower than that of the control group(26.09%vs.62.50%)(P<0.05).There was no significant difference in abortion rate between the two groups after pregnancy(P<0.05).Conclusion The HIFU ablation of uterine fibroids can effectively improve the endometrial receptivity.It has little effect on sex hormone levels,and plays a positive role in the improvement of pregnancy and fertility outcomes.