高强度聚焦超声子宫肌瘤消融术后与子宫肌瘤剔除术后患者妊娠情况比较

发布时间：2018-06-01 20:19

本文选题：高强度聚焦超声(HIFU)子宫肌瘤消融术 + 子宫肌瘤剔除术　；参考：《河北医科大学》2017年硕士论文

【摘要】：目的:比较高强度聚焦超声子宫肌瘤消融术(HIFU)与子宫肌瘤剔除术术后肌瘤复发及妊娠结局;探讨高强度聚焦超声子宫肌瘤消融术用于治疗子宫肌瘤的可行性和术后妊娠情况。方法:选取2012年7月至2014年5月于河北医科大学第二医院接受治疗且有生育要求的符合纳入标准的子宫肌瘤患者。本研究经腔内彩色多普勒超声检查或MRI检查证实有子宫肌瘤且有生育要求的患者126例,在治疗后随访过程中有18例患者失访,最后调查结束共计108例患者纳入研究,分为HIFU组和手术组,其中HIFU组56例,手术组52例。海扶组给予HIFU子宫肌瘤消融治疗;手术组给予子宫肌瘤剔除术治疗;观察两种术式后患者3个月、6个月、12个月、18个月妊娠情况,同时对妊娠结局进行评估。在随访期内对两组患者的术后复发、妊娠、分娩等情况进行对比观察。采用SPSS19.0统计软件进行数据分析,计数资料比较采用t检验,以P0.05表示差异具有统计学意义。结果:1本研究经腔内彩色多普勒超声检查或MRI检查证实有子宫肌瘤且有生育要求的患者108例,其中海扶组56例,手术组52例。其中海扶组年龄在18-44岁之间,平均年龄为31.45±6.163岁,手术组年龄范围为19-45岁,平均年龄为32.62±5.752岁,两者无显著性差异;且两组患者在年龄构成、身高、体重、结婚情况、孕次、产次、术前伴痛经、术前伴小腹疼痛、术前伴CA125异常等方面都没有显著性差异(P0.05);2术后18个月内HIFU组有7名患者发生复发、手术组有6名患者发生复发,复发率分别为12.5%、11.5%,两组复发率比较,无显著性差异(P0.05);3术后18个月内HIFU组有18名妊娠者、手术组有17名妊娠者,妊娠率分别为32.14%、32.69%,两组妊娠率比较,无显著性差异(P0.05);4对两组患者的术后受孕时间进行比较分析,HIFU组和手术组的妊娠时间分别为4.53±2.52月、12.62±7.43月,HIFU组平均术后受孕时间显著低于手术组,两组数据具有显著性差异(P0.05);5两组患者的妊娠年龄比较,两组患者的妊娠年龄以25-34岁比例最高,分别为66.67%和63.15%,而40岁以上者妊娠比例较低,分别为11.11%和5.88%;6两组患者18个月内共妊娠35例,其中HIFU组妊娠人数18例,手术组妊娠人数17例。妊娠后HIFU组和手术组分别有2例和1例患者行人工流产术,HIFU组有1例患者发生胚胎停育,手术组有2例发生胚胎停育。HIFU组顺产9例,剖宫产6例,而手术组顺产3例,剖宫产11例,HIFU组与手术组妊娠期和分娩期均无子宫破裂发生,HIFU组术后剖宫产率明显低于手术组,两组数据具有显著性差异(P0.05);7按照子宫肌瘤的类型分组(FIGO分型),不同类型子宫肌瘤术后妊娠情况如下:2型3例(3/9 33.3%),3型4例(4/17 23.5%),4型24例(24/65 36.9%),5型3例(3/12 25.0%),6型1例(1/5 20.0%)。不同类型子宫肌瘤术后妊娠情况比较,差异无统计学意义(P0.05)。结论:HIFU治疗子宫肌瘤是一种安全有效的非侵入性治疗方法。对有生育要求的患者经HIFU治疗子宫肌瘤后,术后受孕时间显著缩短,HIFU治疗子宫肌瘤具有一定应用推广价值。
[Abstract]:Objective: To compare the recurrence of myoma and pregnancy outcome after the high intensity focused ultrasound hysteromyomectomy (HIFU) and myomectomy, and to discuss the feasibility and pregnancy status of the high intensity focused ultrasound hysteromyomectomy for the treatment of uterine myoma. Methods: from July 2012 to May 2014, the second hospital of Hebei Medical University was selected. 126 patients with uterine leiomyoma and fertility requirements were confirmed by intracavitary color Doppler ultrasonography or MRI examination. 18 patients were lost during the follow-up period after treatment. The final survey ended with a total of 108 patients, divided into HIFU and hands. There were 56 cases in group HIFU and 52 cases in operation group. Haifan group was treated with HIFU uterine myoma; the operation group was treated with hysteromyomectomy, and two kinds of postoperative patients were observed for 3 months, 6 months, 12 months, 18 months of pregnancy, and the pregnancy outcome was evaluated. In the follow-up period, the postoperative recurrence, pregnancy, and childbirth of the two groups were given. The SPSS19.0 statistical software was used to analyze the data. The count data were compared with the t test, and the difference was statistically significant by P0.05. Results: 1 the 108 cases of uterine myoma and reproductive requirements were confirmed by intracavitary color Doppler ultrasonography or MRI examination, including 56 cases in HIFU group and 52 cases in the operation group. Among them, the age of HFU group was 18-44 years old, the average age was 31.45 + 6.163 years old, the age range of the operation group was 19-45 years old and the average age was 32.62 + 5.752 years old. There was no significant difference between the two groups. And the two groups of patients were aged, height, weight, marriage, pregnancy, birth, preoperative accompanied by dysmenorrhea, preoperative with small abdominal pain, preoperative accompanying CA125 abnormality. There were no significant differences (P0.05); 7 patients in group HIFU had relapse within 18 months after 2, and 6 patients in the operation group had recurrence rates of 12.5% and 11.5% respectively. There was no significant difference (P0.05) in the recurrence rate of two groups; 18 PIH in group HIFU was in 18 months after 3, and there were 17 pregnancies in the operation group, and the pregnancy rate was 32.14%, 32.69%, respectively. There was no significant difference in pregnancy rate between the two groups (P0.05); 4 pairs of two groups of patients were compared, the pregnancy time of group HIFU and operation group was 4.53 + 2.52 months, 12.62 + 7.43 months respectively. The average time of postoperative pregnancy in group HIFU was significantly lower than that of the operation group, and the number of two groups had significant difference (P0.05); the pregnancy age of 5 two group patients was in pregnancy age. In the two groups, the pregnancy age of the two groups was the highest of 25-34 years, respectively, 66.67% and 63.15%, while those over 40 years of age were 11.11% and 5.88%, respectively, 11.11% and 5.88% in the 6 two group. Among them, there were 18 cases in group HIFU and the number of pregnancy in the operation group. There were 1 cases of abortion in group HIFU, 9 cases in group.HIFU and 6 cases of cesarean section in the operation group, 3 cases in the operation group and 11 cases of cesarean section in the operation group. There was no rupture of uterus in group HIFU and operation group. The rate of cesarean section in group HIFU was significantly lower than that of the operation group. The two groups of data were significant. Difference (P0.05); 7 according to the type of hysteromyoma type group (FIGO typing), different types of hysteromyoma after operation were as follows: 2 type 3 cases (3/9 33.3%), 3 type 4 cases (4/17 23.5%), 4 type 24 cases (24/65 36.9%), 5 3 cases (1/5), and different types of uterine myoma after surgical pregnancy comparison, the difference was not statistically significant (P0.05). Conclusion there was no statistical difference (P0.05). The treatment of uterine myoma by HIFU is a safe and effective non invasive treatment. After the treatment of uterine myoma by HIFU, the time of pregnancy is significantly shortened after the operation, and HIFU is of certain application value in the treatment of uterine myoma.
【学位授予单位】：河北医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R737.33

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