GnRH-a预处理在高强度聚焦超声治疗严重子宫腺肌病中的作用评价

Evaluation of the effect of pretreatment with GnRH-a before HIFU treatment for severe adenomyosis

目的 探讨使用促性腺激素释放激素激动剂(gonadotropin releasing hormone agonist, GnRH-a)预处理在高强度聚焦超声(high-inteasity focused altrasound, HIFU)治疗子宫腺肌病(adenomyosis, AM)中的作用。方法 回顾性收集克拉玛依市中心医院2019年9月至2022年3月HIFU治疗的严重AM患者,根据HIFU治疗前是否使用GnRH-a,将研究对象分为GnRH-a+HIFU组和HIFU组,从每组中各随机抽取50例比较两组HIFU治疗中的情况、治疗后症状改善及相关指标的变化情况。结果 GnRH-a+HIFU组病灶消融率为(74.14±4.84)%,对照组为(73.06±7.84)%,两组比较差异无统计学意义(P>0.05)。GnRH-a+HIFU组治疗的平均功率(357.26±56.73)W、辐照时间(572.98±230.88)s小于HIFU组(388.24±15.15)W、(862.18±241.53)s,差异有统计学意义(P<0.05)。GnRH-a+HIFU组与HIFU组治疗过程中骶尾部疼痛及下肢放射痛出现的比率差异无统计学意义(P>0.05)。GnRH-a+HIFU组与HIFU组治疗中及治疗后2 h内疼痛评分分别为(2.70±0.95)、(3.06±0.79)VS(3.80±0.90)、(4.02±1.08),差异有统计学意义(P<0.05)。HIFU治疗后3个月,GnRH-a+HIFU组子宫体积缩小程度(174.68±57.59)cm3明显大于HIFU组(107.79±62.84)cm3,差异有统计学意义(P<0.05)。痛经改善及经量减少情况,GnRH-a+HIFU组均优于HIFU组(P<0.05)。结论 HIFU治疗严重的AM前使用GnRH-a可以提高HIFU的治疗效率,减轻治疗中及治疗后的疼痛程度,术后症状改善较好,值得在临床中推广。

Objective To investigate the effect of pretreatment with gonadotropin releasing hormone agonist(GnRH-a)before high-intensity focused ultrasound(HIFU)treatment on adenomyosis(AM).Methods Retrospective analysis of patients with severe AM treated by HIFU from September 2019 to March 2022 in Karamay Central Hospital,the study subjects were divided into GnRH-a+HIFU group and HIFU group according to whether GnRH-a was used before HIFU treatment,and 50 cases were randomly selected from each group to compare the situation in HIFU treatment,the improvement of symptoms after treatment and the changes of related indicators.Results The non-perfused volume ratio of adenomyotic lesions in GnRH-a+HIFU group was(74.14±4.84)%,and it was(73.06±7.84)%in the HIFU group.There was no significant difference between the two groups(P>0.05).The average power and sonication time of GnRH-a+HIFU group were(357.26±56.73)W and(572.98±230.88)s respectively,which were significantly lower than those of HIFU group of(388.24±15.15)W and(862.18±241.53)s(P<0.05).There was no significant difference between GnRH-a+HIFU group and HIFU group in the proportion of sacrococcygeal pain and lower limb radiation pain(P>0.05).The pain scores of GnRH-a+HIFU group during treatment and within 2h after treatment were(2.70±0.95)and(3.06±0.79)respectively,which were significantly lower than those of HIFU group,which were(3.80±0.90)and(4.02±1.08)(P<0.05).Three months after HIFU treatment,the uterine volame reduction in GnRH-a+HIFU group was(174.68±57.59)cm^(3),which was significantly greater than that of HIFU group(107.79±62.84)cm^(3)(P<0.05).The improvement of dysmenorrhea and the reduction of menstrual volume in GnRH-a+HIFU group were better than those in HIFU group(P<0.05).Conclusions Pretreatment with GnRH-a before HIFU treatment for severe AM can improve the efficiency of HIFU treatment,reduce the pain during and after treatment,and improve the postoperative symptoms,which is worthy of clinical promotion.