GnRH-a联合超声造影引导下射频消融术治疗子宫腺肌症疗效

Efficacy of gonadotropin-releasing hormone agonist combined with the contrast-enhanced ultrasound-guided percutaneous radiofrequency ablation for treating adenomyosis

目的:观察促性腺激素释放激素激动剂(GnRH-a)联合超声造影引导下射频消融术(PFA)治疗子宫腺肌症(AM)的临床疗效。方法:选择2019年6月-2022年12月本院收治的AM患者148例,随机分为两组,对照组74例单用超声引导下PFA治疗,观察组74例采用GnRH-a联合超声引导下PFA治疗。对比两组临床疗效,治疗前及治疗3个月后用痛经数字评价量表(NRS)和月经失血图法(PBAC)评分,测量病灶体积和子宫体积,检测血清性激素水平、癌抗原125(CA125)、血管内皮生长因子(VEGF)和血红蛋白(Hb)。结果:治疗后3、6个月,观察组有效率(100%、92.5%)均高于对照组(83.8%、66.2%),复发率(4.1%)低于对照组(12.2%);治疗3个月后两组NRS和PBAC评分均下降,病灶体积和子宫体积均缩小,且观察组降幅大于对照组,观察组血清雌二醇、黄体生成素、卵泡刺激素水平均较对照组降低,CA125、VEGF降低幅度和Hb升高幅度均优于对照组(均P<0.05),不良反应率与对照组(4.1%、0)无差异(P>0.05)。结论:超声造影引导下PFA联合GnRH-a治疗AM能够提高临床疗效,调节性激素水平并降低CA125、VEGF等,有效改善痛经、月经紊乱等症状,并可降低复发率,未增加不良反应。

Objective:To observe the efficacy of gonadotropin-releasing hormone agonist(GnRH-a)combined with contrast-enhanced ultrasound(CEUS)-guided percutaneous radiofrequency ablation(PFA)for treating adenomyosis(AM).Methods:From June 2019to December 2022,148patients with AM were selected and were randomly divided into two groups.74cases in the control group were treated with CEUS-guided PFA alone,and 74cases in the observation group were treated with CEUS-guided PFA combined with GnRH-a.The clinical efficacy,the score of dysmenorrhea by numerical rating scale(NRS),and the score by pictorial blood loss assessment chart(PBAC)before treatment and 3months after treatment of the patients were compared between the two groups.The lesion volume and uterine volume of the patients in the two groups were measured.The levels of serum sex hormone,cancer antigen 125(CA125),vascular endothelial growth factor(VEGF),and hemoglobin(Hb)of the patients in the two groups were detected.Results:The effective rates of the patients in observation group in 3months(100%)and 6months(92.5%)after treatment were significantly higher than those(83.8%and 66.2%)of the patients in the control group,and the recurrence rate(4.1%)of the patients in the observation group was significantly lower than that(12.2%)of the patients in the control group.After 3months of treatment,the NRS and PBAC scores of the patients in both groups had decreased significantly,the lesion volume and the uterine volume of the patients in both groups had decreased significantly,and the change degrees of which of the patients in the observation group were significantly more than those of the patients in the control group.The levels of serum estradiol(E2),luteinizing hormone(LH),and follicle stimulating hormone(FSH)of the patients in the observation group were significantly lower than those of the patients in the control group.The decreasing amplitude of the CA125and VEGF levels and the increasing amplitude of the Hb level of the patients in the observation group were significantly better than those of the patients in the control group(P<0.05).There was no significant difference in the adverse reaction rate(4.1%vs.0)of the patients between the two groups(P>0.05).Conclusion:CEUS-guided PFA combined with GnRH-a for treating the patients with AM can improve their clinical efficacy,and which can regulate the sexual hormone levels,can reduce the levels of CA125and VEGF,can effectively relieve the dysmenorrhea and improve the menstrual disorders,and can reduce the recurrence rate of AM of the patients,without increasing the adverse reaction.