聚焦超声消融手术治疗内在型子宫腺肌病的疗效评价

Clinical efficacy of focused ultrasound ablation surgery in the treatment of internal adenomyosis

目的探讨聚焦超声消融手术(FUAS)治疗内在型子宫腺肌病的疗效及与内膜消融的关系。方法收集2015年1月至2018年12月重庆海扶医院122例临床确诊并接受FUAS治疗的内在型子宫腺肌病患者的临床资料。根据患者意愿决定在消融子宫腺肌病病灶时是否同时消融病灶累及的子宫内膜。通过FUAS治疗后影像学检查评价病灶及内膜消融范围, 随访记录FUAS治疗后24个月内的痛经、经量变化情况, 并记录不良反应发生情况。结果 122例患者中, 90例选择在消融子宫腺肌病病灶的同时行内膜消融, 32例仅消融病灶而内膜未消融。FUAS治疗后, 均未发生肠损伤、神经损伤等严重不良反应。内膜未消融患者的病灶体积消融率中位数为31.7%, 内膜消融患者的病灶体积消融率中位数为60.0%, 两者比较, 差异有统计学意义(P<0.01)。内膜消融患者FUAS治疗后各时间点的痛经评分均显著低于内膜未消融者(P均<0.01);内膜消融患者FUAS前的经量评分[(3.4±0.9)分]高于内膜未消融者(P<0.01), FUAS治疗后各时间点的经量评分均下降, 但与内膜未消融者均无显著差异(P均>0.05)。内膜消融患者FUAS治疗后阴道排液(34.4%, 31/90)及阴道流血(16.7%, 15/90)的发生率显著高于内膜未消融者(P均<0.01)。结论 FUAS可安全有效治疗内在型子宫腺肌病, 同时消融子宫腺肌病病灶及病灶累及的子宫内膜, 可获得更好的疗效。

Objective To investigate the relationship between the clinical efficacy and the ablated area of endometrium in patients with internal adenomyosis treated with focused ultrasound ablation surgery(FUAS).Methods From January 2015 to December 2018,122 patients in Chongqing Haifu Hospital who were diagnosed as internal adenomyosis through history,clinical symptoms and enhanced magnetic resonance imaging(MRI)and treated with FUAS were enrolled in this study.According to the patient′s wishes,patients were given whether to ablate the adenomyotic lesion alone or ablate the adenomyotic lesion and the endometrium that involved in adenomyotic lesions together.The ablated area of adenomyotic lesions and endomitrium were evaluated by post-FUAS enhanced MRI.The adverse events and the changes of dysmenorrhea and menstrual volume at different follow-up points within 24 months were recorded.Results Among the 122 patients,32 patients chose to ablate adenomyotic lesion alone,and 90 patients chose to ablate the adenomyotic lesion and the endometrium during FUAS.No major complications such as bowel injury and nerve injury occurred after FUAS.The median non-perfused volume ratio of adenomyotic lesions was 31.7%in the group without endometrial ablation and it was 60.0%in the group with endometrium ablation(P<0.01).The improvement of dysmenorrhea in the group with endometrium ablation was significantly better than the group without endometrial ablation(P<0.01).The average menstrual volume score(3.4±0.9)before FUAS in the group with endometrial ablation was higher than that in the group without endometrial ablation(2.5±0.6;P<0.01),but it decreased significantly after FUAS treatment,reaching the similar menstrual volume score of the group without endometrial ablation(P>0.05).The proportions of abnormal vaginal discharge(34.4%,31/90)and bleeding(16.7%,15/90)were significantly higher in the group with endometrium ablation than those in the group without endometrial ablation(all P<0.01).Conclusions FUAS could be safely and effectively used in the treatment of patients with internal adenomyosis.It seems that ablation of adenomyotic lesion and endometrium together could obtain better therapeutic effects.