日间手术模式下聚焦超声消融手术治疗子宫肌瘤的可行性及安全性

Feasibility and Safety of Focused Ultrasound Ablation Surgery for Uterine Fibroids under Daytime Surgical Mode

目的:探讨日间手术模式下聚焦超声消融手术治疗子宫肌瘤的可行性及安全性。方法:选取我院2020年1月到2022年12月收治的75例子宫肌瘤患者,分为观察A组、观察B组和对照组,各组均为25例。对照组采取腹腔镜下子宫肌瘤剔除术治疗,观察A组采取常规住院模式聚焦超声消融手术治疗,观察B组采取日间手术模式进行治疗。对比三组患者对子宫肌瘤的治疗效果,手术时间、住院时间、术后VAS评分、术后自主活动时间、治疗费用情况,对比三组患者术后不良反应发生率,最后对所有患者术后3个月进行门诊复查随访,通过症状严重程度(SSS)评分评价患者子宫肌瘤症状,通过MRI影像学检查测量患者子宫肌瘤体积,采用生活质量综合评定问卷-74(GQOLI-74)评价两组患者生存质量。结果:对照组总有效率为100.00%、观察A组为96.00%、观察B组为96.00%,三组总有效率相比差异无统计学意义(P>0.05);三组患者手术时间对比无明显差异(P>0.05),观察B组与观察A组住院时间、术后VAS评分、术后自主活动时间、治疗费用较对照组低,且观察B组的住院时间和治疗费用低于观察A组(P<0.05);观察A组与观察B组术后不良反应发生率较对照组低(P<0.05),且观察A组与观察B组对比无差异(P>0.05);三组患者术前SSS评分、子宫肌瘤体积、GQOLI-74维度均分对比无明显差异(P>0.05),术后三组患者SSS评分、子宫肌瘤体积均降低,GQOLI-74维度均分均升高(P<0.05),但三组患者组间相比差异无统计学意义(P>0.05)。结论:聚焦超声消融手术对子宫肌瘤治疗效果显著,其治疗效果与腹腔镜下子宫肌瘤剔除术相比无显著差异,但可减轻对患者的手术创伤,缩短住院时间、减轻术后疼痛程度,而采取日间手术模式下聚焦超声消融手术治疗子宫肌瘤可进一步缩短患者住院时间,减少手术费用,且安全性较高,对患者预后无明显不良影响,可行性较高。

Objective:To explore the feasibility and safety of focused ultrasound ablation surgery for uterine fibroids under daytime surgical mode.Methods:Patients with uterine fibroids admitted to our hospital from January 2020 to December 2022 were selected as the research subjects.Based on the informed consent of the patients,they were randomly divided into observation group A,observation group B,and control group using a random number table method.Each group had 25 cases.The control group was treated with laparoscopic myomectomy,while the observation group A was treated with conventional hospitalization mode focused ultrasound ablation surgery,while the observation group B was treated with daytime surgery mode.Compare the treatment effectiveness of three groups of patients for uterine fibroids,including surgical time,hospital stay,postoperative VAS score,postoperative autonomous activity time,and treatment cost.Compare the incidence of postoperative adverse reactions among the three groups of patients.Finally,conduct outpatient follow-up at 3 months after surgery for all patients,evaluate the symptoms of uterine fibroids through symptom severity(SsS)score,and measure the volume of uterine fibroids through MRI imaging examination,Evaluate the quality of life of two groups of patients using the Comprehensive Quality of Life Assessment Questionnaire 74(GQOLI-74).Results:The total effective rate of the control group was 100.00%,the observation group A was 96.00%,and the observation group B was 96.00%.There was no difference in the total effective rate among the three groups(P>0.05);There was no difference in surgical time between the three groups of patients(P>0.05).The hospitalization time,postoperative VAS score,postoperative autonomous activity time,and treatment cost of observation group B and observation group A were lower than those of the control group,and the hospitalization time and treatment cost of observation group B were lower than those of observation group A(P<0.05);The incidence of postoperative adverse reactions in Group A and Group B was lower than that in the control group(P<0.05),and there was no difference between Group A and Group B(P>0.05);There was no difference in preoperative SSS score,uterine fibroid volume,and GQOLI-74 dimension average score among the three groups of patients(P>0.05).After surgery,the SSS score and uterine fibroid volume of the three groups of patients decreased,while the GQOLI-74 dimension average score increased(P<0.05).However,there was no difference between the three groups of patients(P>0.05).Conclusion:Focused ultrasound ablation surgery has a significant therapeutic effect on uterine fibroids,and its therapeutic effect is not significantly different from laparoscopic myomectomy.However,it can reduce surgical trauma,shorten hospitalization time,and reduce postoperative pain for patients.Adopting daytime surgery mode focused ultrasound ablation surgery for uterine fibroids can further shorten patient hospitalization time,reduce surgical costs,and have high safety,There is no significant adverse effect on the prognosis of patients,and the feasibility is high.