不同方式治疗子宫腺肌瘤的疗效及妊娠结局的临床分析

doi:10.3969/j.issn.1674-490X.2021.01.004

摘要/Abstract

摘要： 目的比较经腹子宫腺肌瘤局灶切除术、腹腔镜下子宫腺肌瘤局灶切除术及高强度聚焦超声(high intensity focused ultrasound, HIFU)消融3种治疗方法的临床疗效、术后对患者妊娠及其结局的影响。方法回顾性分析2015年10月至2019年4月,保定市妇幼保健院妇科治疗保定地区有生育要求的子宫腺肌瘤患者术后的临床资料,其中经腹子宫腺肌瘤局灶切除术(A组)患者50例,腹腔镜下子宫腺肌瘤局灶切除术(B组)患者45例及HIFU治疗(C组)患者32例,随访4年,比较3组患者手术指标、治疗有效率,调查各组妊娠及其结局情况,并进行统计学分析。结果 A组、B组有效率均达到100%,C组有效率96.88%,但差异无统计学意义(P>0.05)。与A组、B组相比,C组患者手术时间最长,差异有统计学意义(P<0.05),但C组的术中出血量、术后下床活动时间、住院时间均明显少于A组、B组, 差异有统计学意义(P<0.05),A组平均住院费用少于B组、C组,但3组之间差异无统计学意义(P>0.05)。3组比较,C组妊娠率最高(59.38%),A组其次(52.00%),B组最低(48.89%),但差异无统计学意义(P>0.05)。自然流产率、早产率在3组之间差异无统计学意义,但C组患者手术距妊娠的间隔时间明显短于A组、B组,差异有统计学意义(P<0.05)。 3组比较,C组阴道分娩率最高( 52.94%),明显高于A组、B组,差异有统计学意义(P<0.05),但3组的平均分娩孕周、妊娠及并发症发生率、新生儿1 min Apgar评分、术后月经复潮时间差异无统计学意义(P>0.05)。结论 HIFU治疗子宫腺肌瘤安全有效,与经腹子宫腺肌瘤局灶切除术、腹腔镜下子宫腺肌瘤局灶切除术相比,具有一定的优势,不仅能提高受孕率,对妊娠及分娩均无明显不良影响。

关键词: 子宫腺肌瘤, 妊娠, 高强度聚焦超声, 子宫腺肌瘤病灶切除术

Abstract: Objective To compare the clinical efficacy and pregnancy outcomes of the excision of uterine adenomyoma through laparotomy and laparoscopic, and high intensity focused ultrasound(HIFU). Methods The clinical data of postoperative patients with adenomyosis who had fertility requirements were treated with those three ways in Baoding Maternal and Child Heath Hospital from October 2015 to April 2019 were analyzed retrospectively. Among them, group A was treated with laparotomy(group A)(n=50), group B was treated with laparoscopic(n=45), and group C was treated with high intensity focused ultrasound ablation(n=32). All the patients were followed up for 4 years. The operative indexes, treatment efficiency, pregnancy and outcome of each group were investigated and analyzed. Results The effective rate of group A and group B reached 100%, while that of group C was 96.88%, but there was no significant difference between treatment groups(P>0.05). Compared with groups A and B, group C had the longest operation time(P<0.05), but the intraoperative blood loss, the time to get out of bed and the number of hospital stay after operation were significantly lower than those in group A and B(P<0.05). The average hospitalization cost in group A was less than that in group B and C, but there was no significant difference between the three groups(P>0.05).The pregnancy rate was the highest in group C(59.38%), followed by group A(52.00%)and lowest in group B(48.89%), but the difference was not statistically significant(P>0.05). The spontaneous abortion rate, premature delivery rate did not differ significantly among the three groups. Compared with group A and B, group C had the shortest pregnancy interval(P<0.05). The vaginal delivery rate of group C was the highest(52.94%), which was significantly higher than that of group A and B(P<0.05). However, there was no significant difference in the average gestational age, pregnancy complications and complication rate, Apgar score and the time of menstrual resuscitation(P>0.05). Conclusion HIFU treatment of uterine fibroids and adenomyosis is effective and safe, can improve the pregnancy rate without significant adverse effects. Compared with hysteromyoma resection by laparotomy and laparoscopic, HIFU treatment has certain advantages, it is worth in-depth study and promotion.

Key words: denomyoma, pregnancy, high intensity focused ultrasound, hysteromyoma resection

中图分类号:

王纪元,郭战坤,胡雪英,杨颖,王晓娜. 不同方式治疗子宫腺肌瘤的疗效及妊娠结局的临床分析[J]. 医学研究与教育, 2021, 38(1): 23-31.

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