高强度聚焦超声治疗子宫腺肌瘤的临床效果分析

发布时间：2018-05-12 04:23

本文选题：高强度聚焦超声 + 子宫腺肌瘤　；参考：《新乡医学院》2017年硕士论文

【摘要】：背景子宫腺肌瘤(adenomyoma)是女性生殖系统的常见的良性肿瘤,是严重影响女性健康的肿瘤。子宫腺肌瘤的发病率为8.8%-31.0%[1],且发病率逐渐上升。好发于30-50岁经产妇[2],与子宫肌瘤相比较,子宫腺肌瘤的临床症状远远重于它。主要的临床症状有进行性加重的痛经,月经量的异常,月经期的延长等。月经量的增多又会导致贫血,全身乏力,不孕,全身各个系统的疾病等。子宫腺肌瘤的病理基础是有功能的子宫内膜侵入至子宫肌层,出现子宫肌层的增厚,随月经期出现出血,形成局灶性病灶,逐渐发展为肌壁间肿瘤,可出现痛经等严重症状[3-6]。以往治疗子宫腺肌瘤的方法创伤较大,现在患者对于治疗方式也要求的越来越高,患者想要采用保守的治疗方式来保留子宫。高强度聚焦超声(High Intensity Focused Ultrasound,HIFU)是近年来新型的无创治疗的方法,用来治疗实体肿瘤,现逐渐得到广泛患者的关注,作为一种保守性的治疗方式来治疗子宫腺肌瘤[4]。本研究是对比患者在使用高强度聚焦超声治疗前及治疗后的子宫腺肌瘤消融的体积、痛经的改变、月经量的改变及CA125的变化来了解高强度聚焦超声治疗子宫腺肌瘤的有效性。目的研究高强度聚焦超声治疗子宫腺肌瘤的临床效果。方法选择的对象为于2014年9月-2016年9月在新乡医学院第一附属医院治疗的患者,诊断子宫腺肌瘤明确,有月经量增多及痛经症状,且有保留子宫愿望的,愿意接受高强度聚焦超声治疗的子宫腺肌瘤患者。治疗方法:采用的设备是重庆海扶(HIFU)技术有限公司研制聚焦超声肿瘤治疗系统,型号是JC200,对60例(共64个子宫腺肌瘤)患者在镇静镇痛下进行治疗,采取俯卧位,操作过程中采用实时超声声像图引导。观察治疗后3月及6月的指标,通过询问患者临床症状的改变,子宫腺肌瘤在影像检测下的改变,以及实验室指标CA125的变化,来评价高强度聚焦超声治疗子宫腺肌瘤的效果。得到的数据使用SPSS 19.0统计分析,治疗前、治疗后3个月及治疗后6个月各观察指标,两两比较均数的差异,采用q检验来统计分析。结果1.本研究治疗前的临床资料:子宫腺肌瘤体积大小为34.85±17.89 cm3;痛经评分为4.47±2.04分;以患者治疗前的月经量为基数100%,月经量表示为100±0%;CA125的值为129.50±142.03 U/ml。在治疗后第3个月的临床资料:子宫腺肌瘤体积大小为29.27±14.29 cm3;痛经评分为2.98±1.48分;月经量为68±12%;CA125的值为111.63±116.01 U/ml。在治疗后第6个月的临床资料:子宫腺肌瘤体积大小为28.88±11.65 cm3;痛经评分为1.98±1.03分;月经量为52±14%;CA125的值为100.72±103.32 U/ml。2.治疗前、治疗后3月、治疗后6月的各观察指标的数值分别两两进行比较,采用q检验来统计分析。可以得出治疗后3月及治疗后6月的子宫腺肌瘤的体积小于治疗前(P0.05);痛经的评分较前减小(P0.05),症状较前减轻;月经量也有显著的减少(P0.05),CA125的变化(P0.05)。子宫腺肌瘤体积、痛经及月经量及CA125的差异均有统计学意义。3.在选择的60例患者中,并发症出现较少。仅有1例患者出现右下肢麻木症状,待使用营养神经药物(VitB1,Vit B12)3个月后,症状消失。有1例皮肤烧灼,半月后症状消失。有12例患者在接受高强度聚焦超声治疗后当天出现下腹部疼痛症状,经药物镇痛后,症状缓解,1周左右疼痛症状完全消失。结论高强度聚焦超声治疗子宫腺肌瘤的效果明显,可有效的减小子宫腺肌瘤的体积、改善痛经症状,减少月经量并降低CA125的值。治疗后并发症较少,是患者想要采用保守治疗的方法的可行的选择。
[Abstract]:Background adenomyoma (adenomyoma) is a common benign tumor in female reproductive system. It is a tumor that seriously affects women's health. The incidence of adenomyoma is 8.8%-31.0%[1], and the incidence is increasing. The clinical symptoms of uterine adenomyoma are far more serious than that of uterine leiomyoma at 30-50 years of age. The clinical symptoms of the adenomyoma of the uterus are far more serious than that of it. The symptoms of the bed have progressive dysmenorrhea, abnormal menstruation, and prolonged menstruation. The increase of menstruation will lead to anemia, body fatigue, infertility, and systemic diseases. The pathological basis of adenomyoma is the invasion of the endometrium to the myometrium of the uterus, the thickening of the uterine myometrium, and bleeding with the menstrual period. The focal lesions developed gradually into the intramural tumor, and the severe symptoms such as dysmenorrhea, such as dysmenorrhea, may appear in the previous treatment of adenomyoma of the uterus by [3-6]., and the patients are now getting higher and higher for the treatment. The patients want to retain the uterus with conservative treatment. High intensity focused ultrasound (High Intensity Focused Ultras) Ound (HIFU), a new noninvasive treatment in recent years, is used for the treatment of solid tumors and is gradually gaining attention from a wide range of patients. As a conservative treatment for the treatment of adenomyoma of the uterus, the [4]. study is a comparison of the volume of the ablation of the adenomyoma of the uterus before and after the treatment of high intensity focused ultrasound. Changes, changes in the amount of menstruation and changes in CA125 to understand the effectiveness of high intensity focused ultrasound in the treatment of adenomyoma of the uterus. Objective to study the clinical effect of high intensity focused ultrasound in the treatment of adenomyoma of the uterus. Methods selected for the diagnosis of adenomyoma in the First Affiliated Hospital of Xinxiang Medical College in September September 2014, in the diagnosis of adenomyoma. It is clear that the patients with uterine adenomyoma with high intensity of menstruation and dysmenorrhea, and have the desire to retain the uterus, are willing to receive high intensity focused ultrasound treatment of adenomyoma. The equipment used is the development of the focused ultrasound tumor treatment system by Chongqing HIFU Technology Co., Ltd., the type number is JC200, and 60 patients (64 adenomyoma) are in the town. To evaluate the changes in the clinical symptoms of the patients, the changes in the adenomyoma of the uterus under the imaging examination, and the changes in the laboratory index CA125, to evaluate the high intensity focused ultrasound for the treatment of adenomyoma of uterus. The results were obtained by using SPSS 19 statistical analysis, before treatment, 3 months after treatment and 6 months after treatment, 22 comparison of the average number, and using Q test to statistical analysis. Results 1. clinical data before treatment: the size of uterine adenomyoma was 34.85 + 17.89 cm3; the dysmenorrhea score was 4.47 + 2.04 points; patients were treated with the treatment. The amount of menorrhagia before treatment was 100%, the amount of menstruation was 100 + 0%, and the value of CA125 was 129.50 + 142.03 U/ml. in third months after treatment: the volume of adenomyoma was 29.27 + 14.29 cm3; the dysmenorrhea score was 2.98 + 1.48; the amount of menstruation was 68 + 12%; the value of CA125 was the clinical data of 0% months after the treatment. The size of adenomyoma was 28.88 + 11.65 cm3; the dysmenorrhea score was 1.98 + 1.03; the menstrual volume was 52 + 14%; the value of CA125 was 100.72 + 103.32 U/ml.2.. After the treatment in March, the values of the observation indexes in June were compared, and the Q test was used for statistical analysis. Then the March and the June after treatment could be obtained. The volume of uterine adenomyoma was less than that before the treatment (P0.05); the score of dysmenorrhea decreased (P0.05), the symptom was less than before; the amount of menstruation decreased significantly (P0.05), the change of CA125 (P0.05). The volume of adenomyoma, dysmenorrhea, menstrual volume and the difference of CA125 were statistically significant.3. in the selected 60 patients with fewer complications. Only 1 cases were found. The patient appeared numbness of the right lower extremities, and the symptoms disappeared after 3 months of use of VitB1, Vit B12. 1 cases were cauterization of the skin, and the symptoms disappeared after half a month. The symptoms of lower abdominal pain appeared on the day of high intensity focused ultrasound treatment in 12 patients. After the drug town pain, the symptoms were relieved and the pain symptoms disappeared completely around 1 weeks. The effect of high intensity focused ultrasound in the treatment of adenomyoma is obvious. It can effectively reduce the volume of adenomyoma, improve the symptoms of dysmenorrhea, reduce the amount of menstruation and reduce the value of CA125. The complications after treatment are less. It is a feasible choice for patients to adopt conservative treatment.

【学位授予单位】：新乡医学院
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R737.33

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