Embosphere微球子宫动脉栓塞术与高强度聚焦超声对子宫腺肌病患者的影响

The effects of Embosphere microsphere uterine artery embolization and high intensity focused ultrasound on patients with adenomyosis

目的探讨Embosphere微球子宫动脉栓塞术(UAE)与高强度聚焦超声(HIFU)对子宫腺肌病(AM)患者的影响。方法回顾性分析2017年10月至2021年2月沧州市人民医院收治的120例AM患者的临床资料,根据不同治疗方法分为HIFU组和UAE组,每组60例。HIFU组采用HIFU治疗,UAE组采用Embosphere微球UAE治疗。比较两组治疗前后痛经情况、月经情况、子宫体积、病灶体积、临床疗效、卵巢功能、并发症发生率、1年内复发率及妊娠结局。结果治疗后6个月、1年,两组视觉模拟评分法(VAS)、月经失血图(PBAC)评分均低于治疗前(P<0.05)。治疗后6个月、1年,两组子宫体积、病灶体积均小于治疗前(P<0.05)。两组临床总有效率比较,差异无统计学意义(P>0.05)。治疗后6个月、1年,UAE组抗米勒管激素(AMH)、窦卵泡计数(AFC)均低于治疗前,且HIFU组AMH、AFC均高于UAE组(P<0.05)。两组并发症总发生率比较,差异无统计学意义(P>0.05)。HIFU组1年内复发率、妊娠率、活产率均高于UAE组(P<0.05)。结论Embosphere微球UAE与HIFU对AM的治疗效果相当,均可明显缩小病灶,有效改善痛经及月经量情况,Embosphere微球UAE远期复发率更低,HIFU对患者卵巢功能影响较小,有助于改善妊娠结局。因此,有生育意愿的患者首选HIFU治疗,无生育意愿的患者首选Embosphere微球UAE治疗。

Objective To explore the effects of Embosphere microspheres uterine artery embolization(UAE)and high-intensity focused ultrasound(HIFU)on patients with adenomyosis(AM).Methods The clinical data of 120 AM patients admitted to Cangzhou People′s Hospital from October 2017 to February 2021 were retrospectively analyzed.According to different treatment methods,they were divided into HIFU group and UAE group,with 60 cases in each group.HIFU group received HIFU,and UAE group received Embosphere microsphere UAE.The dysmenorrhea condition,menstrual status,uterus volume,lesion volume,clinical efficacy,ovarian function,complication rate,recurrence rate within 1 year,and pregnancy outcomes were compared between the two groups.Results After 6 months and 1 year of treatment,the visual analogue score(VAS)and pictorial blood loss assessment chart(PBAC)scores of the two groups were both lower than those before treatment(P<0.05).After 6 months and 1 year of treatment,the volume of the uterus and lesions were both smaller than those before treatment(P<0.05).There was no statistically significant difference in the total clinical effective rate between the two groups(P>0.05).After 6 months and 1 year of treatment,the levels of anti-Müllerian hormone(AMH)and antral follicle count(AFC)in the UAE group were both lower than those before treatment,and the AMH and AFC levels in the HIFU group were both higher than those in the UAE group(P<0.05).There was no statistically significant difference in the total incidence of complications between the two groups(P>0.05).The one-year recurrence rate,pregnancy rate and the live-birth rate of the HIFU group were all higher than those in the UAE group(P<0.05).Conclusions The therapeutic effects of Embosphere microspheres UAE and HIFU on AM are equivalent,both of which can significantly reduce the lesion and effectively improve the conditions of dysmenorrhea and menstrual volume.Embosphere microsphere UAE has lower long-term recurrence rate,and HIFU has lower impact on the ovarian function of patients,which can help to improve pregnancy outcomes.Therefore,HIFU treatment is preferred for patients with fertility intention,and Embosphere microsphere UAE treatment is preferred for patients without fertility intention.