HIFU治疗子宫肌瘤合并不孕、不良孕产史患者的妊娠结局分析

发布时间：2018-04-29 00:13

  本文选题：高强度聚焦超声 + 子宫肌瘤　； 参考：《重庆医科大学》2016年硕士论文

【摘要】：目的:了解子宫肌瘤合并不孕、不良孕产史患者行高强度聚焦超声(HIFU)治疗后的妊娠情况及分析影响妊娠的相关因素。方法:回顾性研究分析2011年04月01至2014年11月01日重庆海扶医院47例接受HIFU治疗的子宫肌瘤合并不孕、不良孕产史患者的临床资料。记录患者的基本信息、孕产史、肌瘤特征、肌瘤消融率、HIFU治疗强度、术后妊娠间隔时间、妊娠情况等。通过对比分析治疗后妊娠组和未妊娠组患者的年龄、孕产史、肌瘤特征、肌瘤消融率、HIFU治疗强度,探索影响HIFU治疗后妊娠的因素。结果:1.47例行子宫肌瘤HIFU治疗的患者年龄25-45岁,平均34.5±4.8岁。其中治疗前不孕症18例(38.3%)、自然流产26例(55.3%)、死胎1例(2.1%)、辅助生殖失败2例(4.3%)。2.47例患者中21例患者共妊娠24次,均为自然妊娠,总妊娠率为44.7%(21/47),其中活产率为83.3%(20/24)。患者在HIFU治疗后平均8.0±5.4个月受孕,71.4%的患者治疗后受孕时间小于6个月。至2016年02月05日21例患者中20例已分娩,1例处于孕中期(16周)。20例分娩患者中17例足月分娩,3例为早产。20例分娩的患者中2例(10%)顺产,18例(90%)行剖宫产。新生儿均存活。均无子宫破裂发生。3.年龄≤35岁的患者的术后妊娠率为61.5%(16/26)明显高于年龄35岁患者的23.8%(5/21),差异有统计学意义(P0.05);在肌壁间肌瘤影响下,宫腔形态仍居中者治疗后妊娠率66.7%(10/15),宫腔形态变形者治疗后妊娠率30%(6/20),差异有统计学意义(P0.05);治疗后妊娠组患者的肌瘤消融率中位数为90%(80%,98%),而未妊娠组的为80%(74%,80%),差异有统计学意义(P0.05);妊娠组的治疗强度平均为(515.29±136.86)秒/小时,未妊娠组的为(647.92±209.50)秒/小时,差异亦有统计学意义(P0.05)。而两组患者的孕产史及肌瘤的数目、大小、位置差别无统计学意义(P0.05)。结论:对子宫肌瘤合并不孕、不良孕产史的患者行子宫肌瘤HIFU治疗可改善妊娠结局。年龄35岁、肌壁间肌瘤致宫腔形态变形、低消融率、高HIFU治疗强度不利于HIFU治疗后患者妊娠。
[Abstract]:Objective: to investigate the pregnancy status of patients with uterine leiomyoma complicated with infertility and history of bad pregnancy after HIFU (high intensity focused ultrasound) treatment and to analyze the related factors of pregnancy. Methods: the clinical data of 47 cases of uterine leiomyoma complicated with infertility and adverse pregnancy history treated with HIFU from 01 April 2011 to 1 November 2014 in Chongqing Haifu Hospital were retrospectively analyzed. The basic information, history of pregnancy and delivery, characteristics of leiomyoma, ablation rate of myoma and the intensity of HIFU treatment were recorded. By comparing and analyzing the age, history of pregnancy and delivery, characteristics of myoma, ablation rate of myoma and intensity of treatment, the factors influencing pregnancy after HIFU treatment were explored. Results one hundred and forty-seven patients with uterine fibroids treated with HIFU were 25-45 years old with an average age of 34. 5 卤4. 8 years. There were 18 cases of infertility before treatment, 26 cases of spontaneous abortion, 1 case of stillbirth, 2 cases of assisted reproductive failure, and 2 cases of assisted reproductive failure. The total pregnancy rate was 44.7%. The total pregnancy rate was 44.7%, and the live delivery rate was 83.33% 20%. The average gestation time after HIFU treatment was less than 6 months in 71.4% of the patients (8.0 卤5.4 months). By February 5, 2016, 20 out of 21 patients had given birth and 1 was in the second trimester of pregnancy. 17 cases were in term delivery. 3 cases were preterm labor, 2 cases were 10 cases of premature delivery) 18 cases of spontaneous delivery were performed by cesarean section. All newborns survived. No uterine rupture occurred. The postoperative pregnancy rate of patients with age 鈮，

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