摘要
目的 分析超声引导下高强度聚焦超声(HIFU)治疗联合亮丙瑞林治疗子宫肌瘤的临床疗效.方法 前瞻性选取2021年5月至2023年5月枣庄市妇幼保健院妇产科收治的子宫肌瘤患者112例,按照住院号奇偶数法分为观察组(n=56)与对照组(n=56).对照组采用单一 HIFU治疗,观察组在对照组基础上联合亮丙瑞林皮下注射治疗.随访6个月,观察两组的临床疗效、月经量、痛经情况[视觉模拟评分法(VAS)]、子宫体积、子宫内膜容受性[血管搏动指数(PI)、阻力指数(RI)、收缩期峰值血流速度(PSV)]、卵巢功能[血清卵泡刺激素(FSH)、黄体生成素(LH)、雌二醇、雌激素受体(ER)]以及不良反应、肌瘤残留率.结果 观察组显效率为57.14％,总有效率为91.07％,均显著高于对照组(35.71％、76.79％),差异均有统计学意义(P＜0.05).观察组治疗后月经量评分为(95.32±16.43)分,月经量过多率为8.93％,均低于对照组[(117.71±19.64)分、23.21％],差异均有统计学意义(P＜0.05).观察组治疗后6个月的痛经VAS评分为(2.58±0.43)分,低于对照组[(3.45±0.58)分],差异有统计学意义(P＜0.05).观察组治疗后6个月的子宫体积、PSV 分别为(85.37±7.84)cm3、(36.88±4.59)cm/s,均低于对照组[(96.32±6.32)cm3、(40.82±6.31)cm/s],PI、RI 分别为 0.97±0.06、2.79±0.20,均高于对照组(0.88±0.08、2.63±0.15),差异均有统计学意义(P＜0.05).观察组治疗后 6 个月的 FSH、LH、雌二醇、ER 水平分别为(12.26±1.15)IU/L、(7.36±1.66)IU/L、(173.45±35.27)pmol/L、0.81±0.22,均低于对照组[(14.89±1.18)IU/L、(9.85±1.73)IU/L、(188.63±41.38)pmol/L、1.06±0.21],差异均有统计学意义(P＜0.05).观察组患者总不良反应发生率为7.69％,低于对照组(21.43％),内肌瘤残留率为5.36％,低于对照组(16.07％),差异均有统计学意义(P＜0.05).结论 HIFU联合亮丙瑞林治疗子宫肌瘤的临床效果较单一治疗效果佳,能显著改善患者临床症状,且更安全,可能与其改善患者子宫内膜容受性、卵巢功能有关.
Abstract
Objective To analyze the clinical efficacy of ultrasound-guided high intensity focused ultrasound(HIFU)therapy combined with leuprorelin in the treatment of uterine fibroids.Methods A total of 112 patients with uterine fibroids admitted to Zaozhuang Maternal and Child Health Hospital from May 2021 to May 2023 were prospectively selected and divided into the observation group(n=56)and the control group(n=56)according to the odd and even number method of hospitalization number,.The control group was treated with single HIFU,and the observation group was treated with subcutaneous injection of leuprorelin on the basis of the control group,and followed up for 6 months.The patients were followed up for 6 months.The clinical efficacy,menstrual volume,dysmenorrhea[visual analogue scale(VAS)],uterine volume,endometrial receptivity[vascular pulsatility index(PI),resistance index(RI),peak systolic velocity(PSV)],ovarian function[serum follicle stimulating hormone(FSH),luteinizing hormone(LH),estradiol,estrogen receptor(ER)],adverse reactions and residual rate of fibroids were observed in the two groups.Results The marked efficiency(57.14％)and total effective rate(91.07％)of the observation group were signifi-cantly higher than those of the control group(35.71％,76.79％),and the difference were statistically significant(P＜0.05).The menstrual flow score of the observation group after treatment was(95.32±16.43)points,and the rate of menorrhagia was 8.93％,which were significantly lower than those of the control group[(117.71±19.64)points,23.21％],and the difference were statistically significant(P＜0.05).The VAS score of dysmenorrhea in the observation group at 6 months after treatment was(2.58±0.43)points,which was lower than the control group[(3.45±0.58)points],the difference was statistically significant(P＜0.05).The uterine volume and PSV of the observation group at 6 months after treatment were(85.37±7.84)cm3 and(36.88±4.59)cm/s,respectively,which were lower than those of the control group[(96.32±6.32)cm3 and(40.82±6.31)cm/s],PI and RI were 0.97±0.06 and 2.79±0.20,respectively,which were higher than those of the control group(0.88±0.08 and 2.63±0.15),the differences were statistically significant(P＜0.05).The levels of FSH,LH,estradiol and ER in the observation group at 6 months after treatment were(12.26±1.15)IU/L,(7.36±1.66)IU/L,(173.45±35.27)pmol/L and 0.81±0.22,respectively,which were lower than those in the control group[(14.89±1.18)IU/L,(9.85±1.73)IU/L,(188.63±41.38)pmol/L,1.06±0.21],the differences were statistically significant(P＜0.05).The total adverse reaction rate of uterine microcirculation pa-tients in the observation group was 7.69％,which was lower than that in the control group(21.43％),the difference was statistically significant(P＜0.05).The residual rate of fibroids in uterine microcirculation patients within 6 months was 5.36％,which was lower than that in the con-trol group(16.07％),the difference was statistically significant(P＜0.05).Conclusion The clinical effect of HIFU combined with leuprolide in the treatment of uterine fibroids is better than that of single treatment.It can significantly improve the clinical symptoms of patients and is safer,which may be related to the improvement of endometrial receptivity and ovarian function.
NETL
NSTL
万方数据