高强度聚焦超声对子宫肌瘤患者术后血清白介素-10、肿瘤坏死因子-α、C反应蛋白水平及妊娠结局的影响

Effects of high intensity focused ultrasound on serum IL-10,TNF-α,CRP levels and pregnancy outcomes in patients with uterine fibroids

目的探讨高强度聚焦超声(HIFU)对子宫肌瘤患者术后血清白介素-10(IL-10)、肿瘤坏死因子-α(TNF-α)、C反应蛋白(CRP)水平及妊娠结局的影响。方法选取2016年5月至2018年6月诸暨市第二人民医院诊治的93例子宫肌瘤患者作为研究对象。依据治疗方案不同分为HIFU组(n=46)和腹腔镜组(n=47)。HIFU组采取HIFU子宫肌瘤消融术,腹腔镜组采取腹腔镜下子宫肌瘤剔除术。对比两组手术情况,术前、术后当日IL-10、TNF-α、CRP水平,术前、术后3个月子宫内膜容受性指标情况,以及两组肌瘤复发率、妊娠率、妊娠结局。结果 HIFU组手术时间、住院时间、术后恢复正常生活时间短于腹腔镜组,术中出血量少于腹腔镜组(P<0.05);两组术后当天血清IL-10、TNF-α、CRP水平较术前增高,但HIFU组低于腹腔镜组(P<0.05);两组术后3个月子宫内膜容积与厚度均较术前提高,且HIFU组高于腹腔镜组(P<0.05);HIFU组术后18个月妊娠率高于腹腔镜组,剖宫产率低于腹腔镜组(P<0.05)。结论 HIFU治疗子宫肌瘤可降低手术创伤与血清炎症反应水平,促进术后恢复,改善妊娠结局。

Objective To investigate the effect of high-intensity focused ultrasound(HIFU) on postoperative serum interleukin-10(IL-10),tumor necrosis factor-α(TNF-α) and C-reactive protein(CRP) levels and pregnancy outcomes in patients with uterine fibroids. Methods Ninety-three patients with uterine fibroids in the Second people′s Hospital of Zhuji were selected as the research object, and were divided into HIFU group(n=46) and laparoscopic group(n=47) according to different treatment plans. HIFU group was treated with HIFU ablation of uterine fibroids, and laparoscopic group was treated with laparoscopic uterine fibroids removal. The operation conditions, IL-10,TNF-α,and CRP levels before and the day after operation, endometrial receptivity indexes of the two groups before and 3 months after operation were compared between the two groups. The relapse rate, pregnancy rate, and pregnancy outcome of the two groups were compared. Results The operation time, hospital stay and the time of returning to normal life after operation of the HIFU group were shorter than those of the laparoscopic group, and the intraoperative blood loss was lower than that of the laparoscopic group(P<0.05). Serum levels of IL-10,TNF-α,and CRP in the two groups were higher on the day after surgery than before, but the HIFU group was lower than that in the laparoscopic group(P<0.05). The volume and thickness of the endometrium in the two groups at 3 months after operation were higher than that before the operation, and the HIFU group was higher than the laparoscopic group(P<0.05). The pregnancy rate of the HIFU group at 18 months after surgery was 54.55% higher than that of the laparoscopic group 33.33%, and the cesarean section rate was 25.00% lower than that of the laparoscopic group 60.00%(P<0.05). Conclusions HIFU treatment of uterine fibroids can reduce surgical trauma and serum inflammatory reaction levels, promote postoperative recovery, improve pregnancy outcomes.