高强度聚焦超声技术和促性腺激素释放激素激动剂单独或联合治疗子宫腺肌瘤的临床疗效

Clinical efficacy of high-intensity focused ultrasound technology and gonadotropin releasing hormone agonist alone or combination therapy in patients with adenomyoma

目的探讨高强度聚焦超声(HIFU)技术单独或联合促性腺激素释放激素激动剂(GnRH-a)治疗直径较大的子宫腺肌瘤的临床疗效。方法选择2016年6月至2018年6月于新乡医学院第一附属医院收治的90例子宫腺肌瘤4~7 cm的患者为研究对象,根据治疗子宫腺肌瘤的方案分为HIFU组、GnRH-a组、GnRH-a+HIFU组,每组30例。比较3组患者治疗前和治疗后3、6、12个月的病灶体积、痛经视觉模拟评分(VAS)、月经失血图(PBAC)评分及外周静脉血中糖类抗原125水平。结果治疗前,3组患者的病灶体积、痛经VAS评分、PBAC评分及外周静脉血中糖类抗原125水平比较差异无统计学意义(P>0.05)。治疗后3、6、12个月,3组患者的病灶体积、痛经VAS评分、PBAC评分及外周静脉血中糖类抗原125水平均小于治疗前(P<0.05)。治疗后3、6、12个月,HIFU+GnRH-a组患者的病灶体积、痛经VAS评分、PBAC评分、外周静脉血中糖类抗原125水平均显著小于HIFU组和GnRH-a组(P<0.05)。结论HIFU和GnRH-a单独或联合治疗子宫腺肌瘤均安全有效,对于子宫腺肌瘤直径4~7 cm的患者采用GnRH-a和HIFU联合治疗效果更佳。

Objective To investigate the clinical efficacy of high-intensity focused ultrasound(HIFU)technology and gonadotropin releasing hormone agonist(GnRH-a)alone or combination therapy in patients with larger diameter adenomyoma.Methods Ninety patients with adenomyoma with diameter of 4-7 cm admitted to the First Affiliated Hospital of Xinxiang Medical University from June 2016 to June 2018 were selected as the research objects,and they were divided into the HIFU group,GnRH-a group,GnRH-a+HIFU group according to the treatment plan of adenomyoma,30 cases in each group.The lesion volume,visual analogue score(VAS)of dysmenorrhea,pictorial blood loss assessment chart(PBAC)score and carbohyd rate antigen 125 value in peripheral venous blood of patients before treatment and 3,6,12 months after treatment were compared among the 3 groups.Results Before treatment,there was no significant difference in the lesion volume,VAS score of dysmenorrhea,PBAC score and carbohydrate antigen 125 value in peripheral venous blood of patients among the three groups(P>0.05).The lesion volume,VAS score of dysmenorrhea,PBAC score and carbohydrate antigen 125 value in peripheral venous blood of patients at 3,6,12 months after treatment were lower than those before treatment in the 3 groups(P<0.05).At 3,6,12 months after treatment,the lesion volume,VAS score of dysmenorrhea,PBAC score and carbohydrate antigen 125 value in peripheral venous blood of patients in the HIFU+GnRH-a group were significantly lower than those in the HIFU group and GnRH-a group(P<0.05).Conclusion HIFU and GnRH-a alone or in combination therapy are safe and effective in the patients with adenomyoma.For patients with adenomyoma with diameter of 4-7 cm,the combined treatment of GnRH-a and HIFU has a better effect.