高强度聚焦超声消融联合促性腺激素释放激素激动剂治疗子宫肌瘤的临床疗效观察

Observation on the clinical efficacy of high-intensity focused ultrasound ablation combined with gonadotropin-releasing hormone agonist in the treatment of hysteromyoma

目的比较单纯高强度聚焦超声(HIFU)与HIFU联合促性腺激素释放激素激动剂(GnRH-a)用于子宫肌瘤治疗的应用效果及安全性。方法回顾性分析2022年8月至2023年1月北京协和医院聚焦超声消融治疗中心收治的120例接受HIFU治疗的子宫肌瘤患者的临床资料,根据治疗方式的不同进行分组:GnRH-a预处理联合HIFU治疗组(A组)36例、HIFU治疗后联合GnRH-a治疗组(B组)19例、单纯HIFU治疗组(C组)65例。于治疗后1、6、12个月分别评估子宫肌瘤体积、子宫肌瘤症状评分、血红蛋白水平等。结果3组患者治疗前的一般情况(包括年龄、体质量指数、病灶体积等)比较无显著性差异(P>0.05)。A组的HIFU治疗总能量显著低于B组(P<0.05)。治疗后,3组患者的子宫肌瘤体积均显著缩小(P<0.05)、子宫肌瘤症状评分均显著降低(P<0.05)、血红蛋白水平均显著升高(P<0.05)。HIFU治疗后1个月,3组患者间子宫肌瘤症状评分、血红蛋白水平比较无显著性差异(P>0.05);HIFU治疗后6个月和12个月,A、B组的子宫肌瘤症状评分显著低于C组(P<0.05),血红蛋白水平显著高于C组(P<0.05)。HIFU治疗后12个月,C组有4例(6.15%)患者复发,A、B组无患者复发。3组均无HIFU相关的严重不良反应发生。结论HIFU联合GnRH-a治疗子宫肌瘤是安全有效的,症状缓解率和子宫肌瘤缩小率有高于单独使用HIFU治疗的趋势,且复发率明显降低。

Objective:To compare the therapeutic effects and safety of high-intensity focused ultrasound(HIFU)alone and HIFU combined with gonadotropin releasing hormone agonist(GnRH-a)in the treatment of uterine fibroids.Methods:A retrospective analysis was conducted on the clinical data of 120 patients with uterine fibroids who received HIFU treatment.Among them,36 cases underwent pre-treatment of GnRH-a combined with HIFU(group A),and 19 cases were treated with GnRH-a after HIFU treatment(group B),65 cases were treated with HIFU alone(group C).Uterine fibroid volume,uterine fibroid symptom score,and hemoglobin(Hb)levels were assessed at 1,6,and 12 months after HIFU.Results:There were no significant differences in the age,body mass index and the volume of uterine fibroids among the three groups(P>0.05).The total therapeutic energy of group A was significantly lower than that of group B(P<0.05).After treatment,the volume of uterine fibroids in the three groups significantly decreased(P<0.05),the symptom score of uterine fibroids significantly decreased(P<0.05),and the Hb level significantly increased(P<0.05).One month after HIFU,there were no statistically significant differences in uterine fibroid symptom scores and Hb levels among the three groups(P>0.05).However,at 6 and 12 months after HIFU,the symptom scores of uterine fibroids in group A and B were significantly lower than that of group C(P<0.05),while Hb levels were significantly higher(P<0.05).At 12 months after HIFU,four patients in group C,while none in group A and B,experienced recurrence.No serious adverse reactions were found in the three groups.Conclusions:HIFU combined with GnRH-a can be effectively and safely applied in the treatment of uterine fibroids with the trend of higher symptom relief and uterine fibroid reduction rates as well as lower recurrence rate.