超声引导经皮微波消融治疗子宫腺肌病的临床研究
发布时间：2018-09-09 16:06
【摘要】：目的 1、评估超声引导经皮微波消融（Percutaneous microwave abltion, PMWA）治疗症状性子宫腺肌病的安全性；2、对经PMWA治疗后，症状性子宫腺肌病患者临床疗效的改善进行探讨。 材料与方法 1、安全性研究：185例症状性子宫腺肌病患者接受PMWA治疗，记录消融后患者可能出现的相关不良反应，并根据国际介入放射治疗协会制定的SCVIR分类法对其进行评价。对患者3、6、9、12个月血清雌二醇（Estradiol, E2）及卵泡刺激素（Follicle-Stimulating Hormone, FSH）水平进行统计分析，同时记录患者月经、妊娠、更年期相关症状等，探讨治疗对患者卵巢及子宫内膜功能的影响。 2、疗效研究:对经PMWA治疗的症状性子宫腺肌病患者消融后3、6、9、12月的痛经评分、子宫体积、贫血患者血红蛋白改善及子宫肌瘤症状及与健康相关生活质量（The Uterine Fibroid Symptom and Quality of Life, UFS-QOL）问卷得分进行统计分析，并进一步对弥漫性及局限性子宫腺肌病患者PMWA治疗后改善进行分类讨论。同时，记录患者消融前及消融后3、6、9、12个月血清癌抗原125（cancerantigen125，CA125）及泌乳素（Prolactin, PRL）水平，以进一步评价消融效果。 结果 1、安全性研究：消融后患者一般情况良好，SCVIR分类中除1名患者为C类，其余均为A或B类。患者主要不良反应包括：阴道流液，多为淡粉色且1月内消失，1例为血性，并于治疗后2天出现高热，再次入院给予止血、缩宫等对症治疗后好转；治疗区疼痛，92例于消融后6小时内出现，给予一次止痛药物后症状消失；发热，共14例，1例为中等热度，其余为低热，平均体温37.5±0.2℃；镜下血尿，共18例于治疗后4小时内出现，考虑为置入导尿管刺激所致，未予特殊处理，2-4日后复查尿常规正常；坏死组织自然排出，，共23例于治疗后1-12个月出现。患者消融前后E2及FSH定量比较差异均无统计学意义（p＞0.05）。1例患者出现宫腔黏连，给予黏连分解术后月经正常来潮，其余患者月经周期及经期持续时间正常。消融后共有5例患者6次自然受孕，人工流产5次，待产1例。 2、疗效研究：复查各时期痛经评分、子宫体积、贫血患者血红蛋白定量及UFS-QOL问卷得分情况与治疗前相比均明显好转（p＜0.05）。治疗后弥漫性与局限性子宫腺肌病相比，上述各项指标差异均无明显统计学意义（p＞0.05）。治疗后患者血清CA125及PRL均较治疗前明显下降（p＜0.05），进一步将二者与腺肌病主要症状改善情况进行相关分析，结果显示：CA125与痛经、子宫体积变化正相关（相关系数分别为0.374、0.440，p＜0.05）；而PRL与上述三项变化未呈现出明显的统计学相关性（p＞0.05）；同时，CA125与PRL的相关性无明显统计学意义（p＞0.05）。 结论 1、安全性研究：（1）PMWA治疗症状性子宫腺肌病，消融后患者无子宫周围脏器器质性损害，但为保证消融安全性，治疗中仍需密切监测热场高回声范围。（2）超声引导经皮微波消融治疗子宫腺肌病技术对患者卵巢及内膜功能均无明显影响。患者仍有再次妊娠可能，但对于有强烈妊娠要求者，仍需慎重。 2、疗效研究：（1）PMWA治疗子宫腺肌病能明显缩小子宫体积，减轻痛经、贫血等症状，提高患者生活质量。（2）弥漫性子宫腺肌病与局限性子宫腺肌病的PMWA治疗均可得到满意临床疗效。（3）PMWA治疗子宫腺肌病患者血清CA125及PRL显著下降，且CA125的变化与子宫体积及痛经情况变化间存在相关性。
[Abstract]:objective
1. To evaluate the safety of ultrasound-guided percutaneous microwave ablation (PMWA) in the treatment of symptomatic adenomyosis; 2. To explore the improvement of clinical efficacy in patients with symptomatic adenomyosis after PMWA treatment.
Materials and methods
1. Safety study: 185 patients with symptomatic adenomyosis were treated with PMWA. Possible adverse reactions after ablation were recorded and evaluated according to the SCVIR classification established by the International Association for Interventional Radiotherapy. Ng Hormone, FSH) levels were statistically analyzed, and the symptoms related to menstruation, pregnancy and menopause were recorded to explore the effects of treatment on ovarian and endometrial function.
2. Efficacy study: The dysmenorrhea score, uterine volume, hemoglobin improvement, uterine fibroids symptoms and the health-related quality of life (UFS-QOL) questionnaire scores of symptomatic adenomyosis patients treated with PMWA at 3, 6, 9, and 12 months after ablation were statistically analyzed and further analyzed. The improvement of PMWA in patients with diffuse and localized adenomyosis was discussed. The serum levels of cancer antigen 125 (CA125) and prolactin (PRL) were recorded before and 3,6,9,12 months after ablation to further evaluate the ablation effect.
Result
1. Safety study: After ablation, the general condition of patients is good, except one patient in SCVIR classification for C, the rest are A or B. The main adverse reactions include: vaginal bleeding, mostly pale pink and disappeared within 1 month, 1 case of hemorrhagic, and 2 days after the treatment of high fever, re-admission to the hospital for hemostasis, uterine contraction and other symptomatic treatment for improvement; Regional pain occurred in 92 cases within 6 hours after ablation, and symptoms disappeared after treatment with a painkiller; fever occurred in 14 cases, moderate fever in 1 case, and low fever in the rest, with an average body temperature of 37.5 [0.2]; microscopic hematuria occurred in 18 cases within 4 hours after treatment, and was considered to be caused by catheter stimulation without special treatment. There was no significant difference in the amount of E2 and FSH between before and after ablation (p > 0.05). One patient developed intrauterine adhesions and normal menstruation after decomposition of adhesions. The rest had normal menstrual cycle and duration. Natural conception, artificial abortion 5 times, 1 cases of labor.
2. Efficacy study: The dysmenorrhea score, uterine volume, hemoglobin quantification and UFS-QOL score of anemia patients were significantly improved after treatment (p < 0.05). There was no significant difference between diffuse and localized adenomyosis after treatment (p > 0.05). The results showed that CA125 was positively correlated with dysmenorrhea and uterine volume changes (correlation coefficients were 0.374, 0.440, P < 0.05), while PRL was not significantly correlated with the above three changes (p > 0.05). At the same time, the correlation between CA125 and PRL was not statistically significant (P > 0.05).
conclusion
1. Safety study: (1) PMWA treatment of symptomatic adenomyosis, ablation of patients without periuterine organs damage, but to ensure the safety of ablation, the treatment still needs to closely monitor the range of high echo in the thermal field. (2) ultrasound-guided percutaneous microwave ablation of adenomyosis in patients with ovarian and endometrial function were not significantly affected. Pregnant women may still have another pregnancy, but caution is needed for those who have strong pregnancy requirements.
2. Efficacy study: (1) PMWA treatment of adenomyosis can significantly reduce uterine volume, alleviate dysmenorrhea, anemia and other symptoms, improve the quality of life of patients. (2) Diffuse adenomyosis and localized adenomyosis PMWA treatment can be satisfied with clinical efficacy. (3) PMWA treatment of adenomyosis patients serum CA125 and PRL significantly decreased, and CA125. There was a correlation between the changes of uterine volume and dysmenorrhea.
【学位授予单位】：中国人民解放军医学院
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R711.71;R445.1
[Abstract]:objective
1. To evaluate the safety of ultrasound-guided percutaneous microwave ablation (PMWA) in the treatment of symptomatic adenomyosis; 2. To explore the improvement of clinical efficacy in patients with symptomatic adenomyosis after PMWA treatment.
Materials and methods
1. Safety study: 185 patients with symptomatic adenomyosis were treated with PMWA. Possible adverse reactions after ablation were recorded and evaluated according to the SCVIR classification established by the International Association for Interventional Radiotherapy. Ng Hormone, FSH) levels were statistically analyzed, and the symptoms related to menstruation, pregnancy and menopause were recorded to explore the effects of treatment on ovarian and endometrial function.
2. Efficacy study: The dysmenorrhea score, uterine volume, hemoglobin improvement, uterine fibroids symptoms and the health-related quality of life (UFS-QOL) questionnaire scores of symptomatic adenomyosis patients treated with PMWA at 3, 6, 9, and 12 months after ablation were statistically analyzed and further analyzed. The improvement of PMWA in patients with diffuse and localized adenomyosis was discussed. The serum levels of cancer antigen 125 (CA125) and prolactin (PRL) were recorded before and 3,6,9,12 months after ablation to further evaluate the ablation effect.
Result
1. Safety study: After ablation, the general condition of patients is good, except one patient in SCVIR classification for C, the rest are A or B. The main adverse reactions include: vaginal bleeding, mostly pale pink and disappeared within 1 month, 1 case of hemorrhagic, and 2 days after the treatment of high fever, re-admission to the hospital for hemostasis, uterine contraction and other symptomatic treatment for improvement; Regional pain occurred in 92 cases within 6 hours after ablation, and symptoms disappeared after treatment with a painkiller; fever occurred in 14 cases, moderate fever in 1 case, and low fever in the rest, with an average body temperature of 37.5 [0.2]; microscopic hematuria occurred in 18 cases within 4 hours after treatment, and was considered to be caused by catheter stimulation without special treatment. There was no significant difference in the amount of E2 and FSH between before and after ablation (p > 0.05). One patient developed intrauterine adhesions and normal menstruation after decomposition of adhesions. The rest had normal menstrual cycle and duration. Natural conception, artificial abortion 5 times, 1 cases of labor.
2. Efficacy study: The dysmenorrhea score, uterine volume, hemoglobin quantification and UFS-QOL score of anemia patients were significantly improved after treatment (p < 0.05). There was no significant difference between diffuse and localized adenomyosis after treatment (p > 0.05). The results showed that CA125 was positively correlated with dysmenorrhea and uterine volume changes (correlation coefficients were 0.374, 0.440, P < 0.05), while PRL was not significantly correlated with the above three changes (p > 0.05). At the same time, the correlation between CA125 and PRL was not statistically significant (P > 0.05).
conclusion
1. Safety study: (1) PMWA treatment of symptomatic adenomyosis, ablation of patients without periuterine organs damage, but to ensure the safety of ablation, the treatment still needs to closely monitor the range of high echo in the thermal field. (2) ultrasound-guided percutaneous microwave ablation of adenomyosis in patients with ovarian and endometrial function were not significantly affected. Pregnant women may still have another pregnancy, but caution is needed for those who have strong pregnancy requirements.
2. Efficacy study: (1) PMWA treatment of adenomyosis can significantly reduce uterine volume, alleviate dysmenorrhea, anemia and other symptoms, improve the quality of life of patients. (2) Diffuse adenomyosis and localized adenomyosis PMWA treatment can be satisfied with clinical efficacy. (3) PMWA treatment of adenomyosis patients serum CA125 and PRL significantly decreased, and CA125. There was a correlation between the changes of uterine volume and dysmenorrhea.
【学位授予单位】：中国人民解放军医学院
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R711.71;R445.1
【共引文献】
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