目的 探讨高强度聚焦超声消融手术(FUAS)联合左炔诺孕酮宫内缓释系统(LNG-IUS)及地诺孕素(Dienogest,DNG)治疗子宫腺肌病(AM)的临床疗效。方法 回顾性分析2018-01至2020-10石家庄市第六医院聚焦超声治疗科确诊为AM患者150例,根据术后应用药物不同分为:A组(单纯FUAS治疗)、B组(FUAS+LNG-IUS)和C组(FUAS+DNG),每组50例。记录3组患者治疗前(T1)、治疗后3个月(T2)、6个月(T3)及12个月(T4)时,子宫体积、病灶体积、痛经评分、血红蛋白(Hb)、血CA125及并发症的情况,并进行对比分析。结果 与T1比较,3组患者T2-T4时子宫体积、病灶体积明显缩小(P<0.01),CA125水平、VAS评分明显降低,HB水平明显升高,差异有统计学意义(P<0.01);与A组比较, B、C两组T4时子宫体积、病灶体积明显缩小,CA125水平、VAS评分明显降低,差异有统计学意义(P<0.01);B、C两组间比较,C组T4时患者子宫体积、CA125水平、VAS评分明显低于B组,差异有统计学意义(P<0.01)。结论 三种方法均能缓解AM患者的临床症状,但FUAS 联合DNG治疗在缓解痛经和预防复发方面,优于单纯FUAS 和FUAS 联合LNG-IUS。
Abstract
Objective To compare the clinical effect of only high intensity focused ultrasound ablation surgery (FUAS), FUAS combined with levonorgestrel releasing intrauterine system (LNG-IUS) and FUAS combined with dienogest(DNG) in the treatment of adenomyosis(AM). Methods A total of 150 patients with AM, who were treated in our hospital, were divided into three groups according to the difference of drug use: group A (FUAS treatment only), group B (FUAS combined with LNG-IUS) and group C (FUAS combined with DNG), with 50 cases in each group. The uterine volume, lesion volume, dysmenorrhea score, hemoglobin (HB) and level of serum CA125 were recorded separately at four points, namely before ablation (T1), 3 th(T2) ,6 th(T3) and 12 th(T4) month after ablation. Results Compared with the point of T1, at the points of T2-T4, the uterine volume, lesion volume, serum CA125 and VAS scores decreased (P<0.01) and HB became significantly higher (P<0.01) in the three groups. At the point of T4, the above mentioned four data were lower (P<0.05 ) in group B and group C than those in group A, and the uterine volume, dysmenorrhea score and serum CA125 in group C were significantly lowerthan those in group B (P<0.01). Conclusions The three treatment methods of FUAS are effective to prevent the recurrence and improve the clinical symptoms effectively, especially the treatment of FUAS combined with DNG.
关键词
子宫腺肌病 /
高强度聚焦超声消融术 /
左炔诺孕酮宫内缓释系统 /
地诺孕素 /
CA125
Key words
adenomyosis /
high intensity focused ultrasound ablation surgery /
levonorgestrel releasing intrauterine system /
dienogest /
CA125
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基金
河北省医学科学研究重点课题(20191417)
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