HIFU和UEA治疗弥漫型和局限型子宫腺肌病的近远期疗效比较

Comparison of short-term and long-term efficacy of HIFU and UEA in the treatment of diffuse and localized adenomyosis

目的探讨高强度聚焦超声(high intensity focused ultrasound,HIFU)和子宫动脉栓塞术(uterine artery embolization,UEA)治疗弥漫型和局限型子宫腺肌病的近远期疗效差异。方法选取在河北省沧州市人民医院妇科接受治疗的子宫腺肌病患者120例,其中弥漫型组(D组)和局限型组(L组)各60例,据治疗方法不同,D组和L组分为D1、D2亚组以及L1、L2亚组,D1组和L1组进行HIFU治疗,D2组和L2组进行UEA治疗,记录并比较各组治疗前、治疗后6个月、12个月症状严重程度评分、痛觉视觉模拟评分、月经量的月经失血图评分及健康相关生命质量评分;测量治疗12个月后子宫体积和病灶体积,测定2组治疗前、治疗后12个月的促卵泡激素(follicle-stimulating hormone,FSH)、促黄体生成素(luteinizing hormone,LH)、雌二醇(estradiol,E2)、抗苗勒管激素(anti-mullerian hormone,AMH)水平及窦卵泡(antral follicle,AFC)变化。计算4组12个月的临床疗效,随访24个月,记录复发情况。结果4组在治疗后6个月及12个月症状严重程度评分、痛觉视觉模拟评分、月经量的月经失血图评分均明显下降(P<0.05),健康相关生命质量评分明显增加(P<0.05),但4组间差异无统计学意义(P>0.05)。与治疗前相比,治疗后12个月4组的子宫体积和病灶体积均明显减少,差异有统计学意义(P<0.05),且D1组小于D2组,L1组小于L2组,差异均有统计学意义(P<0.05)。4组治疗后12个月FSH、LH、E2均明显降低,差异有统计学意义(P<0.05),且D1组FSH、LH、E2明显低于D2组,AMH水平明显高于D2组(P<0.05),L1组FSH、LH明显低于L2组,AMH水平明显高于L2组(P<0.05),而4组间AFC差异无统计学意义(P>0.05),4组的总有效率和复发率差异无统计学意义(P>0.05)。结论HIFU治疗弥漫型和局限型子宫腺肌病近期疗效和远期复发率与UEA无异,可根据具体情况选择合适的治疗方案。

Objective To compare the short-term and long-term efficacy of high intensity focused ultrasound(HIFU)and uterine artery embolization(UAE)in the treatment of diffuse and localized adenomyosis.Methods A total of 120 patients with adenomyosis who received treatment in the Department of Gynecology,Cangzhou People's Hospital were selected.The patients were classified into diffuse group(group D,n=60)and limited group(group L,n=60).According to different treatment methods,Groups D and L were divided into subgroups D1,D2 and subgroups L1,L2,respectively.Groups D1 and L1 were treated with HIFU,and groups D2 and L2 were treated with UAE.Symptom severity score(SSS),visual analogue scale(VAS)pain score,Pictorial Blood Loss Assessment Chart(PBAC)score of menstrual volume and health-related quality of life(HRQL)score of each group were recorded and compared before treatment,and at 6 and 12 months after treatment.The uterine volume and lesion volume were evaluated at 12 months after treatment,and the follicle-stimulating hormone(FSH),luteinizing hormone(LH),estradiol(E2),anti-mullerian hormone(AMH)levels and antral follicle(AFC)of the two groups were measured before and at 12 months after treatment.The clinical efficacy of the two groups was calculated for 12 months,they were followed up for 24 months,and the recurrence was recorded.Results SSS,VAS pain score and PBAC score of menstrual volume were decreased significantly at 6 and 12 months after treatment in the four groups(P<0.05),and HRQL score was increased significantly(P<0.05).However,there was no significant difference among the four groups(P>0.05).Compared with those before treatment,the uterine volume and lesion volume of the four groups were significantly reduced at 12 months after treatment,showing significant differences(P<0.05),which were smaller in group D1 than in group D2,as well as in group L1 group than in group L2,suggesting significant differences(P<0.05).The levels of FSH,LH and E2 in the four groups were significantly lower after treatment,as compared with those before treatment,and significantly lower in group D1 than in group D2(P<0.05),while the level of AMH in group D1 was significantly higher than that in group D2(P<0.05).The levels of FSH and LH in group L1 were significantly lower than those in group L2,while AMH level was significantly higher than that in group L2(P<0.05);however,AFC was not significantly different among the four groups(P>0.05).There was no significant difference in the total effective rate and recurrence rate among the four groups(P>0.05).Conclusion HIFU is comparable to UAE in short-term and long-term efficacy in the treatment of diffuse and localized adenomyosis.Therefore,the appropriate treatment plan can be selected according to the specific situation.