丙酸睾丸酮在高强度聚焦超声治疗子宫腺肌病中的应用价值

发布时间：2018-12-31 21:58

【摘要】：研究背景：子宫腺肌病是育龄期妇女常见的一种良性病变，临床表现为进行性加重的痛经、月经过多、不孕等。因其病灶边界不清又无包膜，致使保守性手术治疗的复发率较高，一直是临床医生面临的难题。高强度聚焦超声(HIFU)利用超声波的穿透性和可聚焦性，使靶区组织发生凝固性坏死，从而达到治疗肿瘤的目的。HIFU作为一种无创治疗的方法，能显著改善腺肌病患者痛经、月经过多等临床症状，而对卵巢内分泌功能影响甚小。丙酸睾丸酮是一种雄激素类药物，可以降低或抑制雌激素水平,使异位内膜萎缩,子宫血管收缩。HIFU治疗前短时间使用可减少子宫血供，缩小子宫体积，这为改变组织声环境，提高治疗效率提供了可能。本课题将探讨丙酸睾丸酮在HIFU治疗子宫腺肌病中的作用及其安全性问题。目的：评估丙酸睾丸酮在HIFU治疗子宫腺肌病中的应用价值。资料和方法：回顾性分析重庆涪陵中心医院经HIFU治疗的62例子宫腺肌病患者。比较使用丙酸睾丸酮组及对照组在治疗时间、辐照时间、能效因子（EEF）、消融率、出现团块状灰度变化情况。并评价HIFU治疗子宫腺肌病的安全性问题。结果：丙酸睾丸酮组与对照组比较，两组在治疗中的治疗时间、辐照时间、EEF和消融率上无显著差异。在丙酸睾丸酮组的患者中，病灶出现团块状灰度变化的比例为80%（32/40）；而对照组中出现团块状灰度变化的比例为50%（11/22）。结果显示丙酸睾丸酮组的病灶出现团块状灰度变化的概率大于对照组，，有显著差异（χ2=6.010，P=0.014）；但两组比较，出现团块状灰度变化的时间无显著差异（t=0.613，P=0.542）。两组患者未出现严重的副反应。结论： 1.丙酸睾丸酮不能有效地增强HIFU治疗子宫腺肌病的效率，但对提高团块状灰度出现的概率有意义，有利于HIFU治疗的监控。 2.镇静镇痛下HIFU治疗子宫腺肌病是安全有效的。
[Abstract]:Background: adenomyosis is a common benign disease in women of childbearing age. Its clinical manifestations are progressive aggravation of dysmenorrhea, menorrhagia, infertility and so on. The recurrence rate of conservative surgical treatment is high because of its unclear boundary and no capsule, which has always been a difficult problem for clinicians. High intensity focused ultrasound (HIFU) makes use of the penetrating and focusing properties of ultrasound to cause coagulation necrosis of the target tissue, thus achieving the purpose of treating tumor. As a noninvasive treatment method, HIFU can significantly improve dysmenorrhea in patients with adenomyosis. Menstruation and other clinical symptoms, but the ovarian endocrine function has little impact. Testosterone propionate is a androgen drug that reduces or suppresses estrogen levels, causes ectopic endometrial atrophy and uterine vasoconstriction. Improved treatment efficiency provides the possibility. The purpose of this study was to investigate the role and safety of testosterone propionate in the treatment of adenomyosis with HIFU. Objective: to evaluate the value of testosterone propionate in the treatment of adenomyosis with HIFU. Materials and methods: 62 cases of adenomyosis treated by HIFU in Fuling Central Hospital of Chongqing were retrospectively analyzed. The treatment time, irradiation time and (EEF), ablation rate of energy efficiency factor were compared between the testosterone propionate group and the control group. To evaluate the safety of HIFU in the treatment of adenomyosis. Results: there was no significant difference in treatment time, irradiation time, EEF and ablation rate between testosterone propionate group and control group. In the testosterone propionate group, 80% (32 / 40) of the lesions had mass gray changes, while 50% (11 / 22) in the control group. The results showed that the probability of mass gray scale change in testosterone propionate group was significantly higher than that in control group (蠂 ~ 2 = 6.010 ~ P ~ (0.014). However, there was no significant difference between the two groups in the time of mass gray change (t0. 613, P < 0. 542). There were no serious side effects in both groups. Conclusion: 1. Testosterone propionate can not effectively enhance the efficiency of HIFU in the treatment of adenomyosis, but it is significant to increase the probability of mass gray level, which is beneficial to the monitoring of HIFU therapy. 2. HIFU is safe and effective in the treatment of adenomyosis under sedation and analgesia.
【学位授予单位】：重庆医科大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R711.71

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