本文選題：高強(qiáng)度聚焦超聲 + 子宮肌瘤�。� 參考：《重慶醫(yī)科大學(xué)》2016年碩士論文

【摘要】：目的:了解子宮肌瘤合并不孕、不良孕產(chǎn)史患者行高強(qiáng)度聚焦超聲(HIFU)治療后的妊娠情況及分析影響妊娠的相關(guān)因素。方法:回顧性研究分析2011年04月01至2014年11月01日重慶海扶醫(yī)院47例接受HIFU治療的子宮肌瘤合并不孕、不良孕產(chǎn)史患者的臨床資料。記錄患者的基本信息、孕產(chǎn)史、肌瘤特征、肌瘤消融率、HIFU治療強(qiáng)度、術(shù)后妊娠間隔時(shí)間、妊娠情況等。通過對比分析治療后妊娠組和未妊娠組患者的年齡、孕產(chǎn)史、肌瘤特征、肌瘤消融率、HIFU治療強(qiáng)度,探索影響HIFU治療后妊娠的因素。結(jié)果:1.47例行子宮肌瘤HIFU治療的患者年齡25-45歲,平均34.5±4.8歲。其中治療前不孕癥18例(38.3%)、自然流產(chǎn)26例(55.3%)、死胎1例(2.1%)、輔助生殖失敗2例(4.3%)。2.47例患者中21例患者共妊娠24次,均為自然妊娠,總?cè)焉锫蕿?4.7%(21/47),其中活產(chǎn)率為83.3%(20/24)�；颊咴贖IFU治療后平均8.0±5.4個(gè)月受孕,71.4%的患者治療后受孕時(shí)間小于6個(gè)月。至2016年02月05日21例患者中20例已分娩,1例處于孕中期(16周)。20例分娩患者中17例足月分娩,3例為早產(chǎn)。20例分娩的患者中2例(10%)順產(chǎn),18例(90%)行剖宮產(chǎn)。新生兒均存活。均無子宮破裂發(fā)生。3.年齡≤35歲的患者的術(shù)后妊娠率為61.5%(16/26)明顯高于年齡35歲患者的23.8%(5/21),差異有統(tǒng)計(jì)學(xué)意義(P0.05);在肌壁間肌瘤影響下,宮腔形態(tài)仍居中者治療后妊娠率66.7%(10/15),宮腔形態(tài)變形者治療后妊娠率30%(6/20),差異有統(tǒng)計(jì)學(xué)意義(P0.05);治療后妊娠組患者的肌瘤消融率中位數(shù)為90%(80%,98%),而未妊娠組的為80%(74%,80%),差異有統(tǒng)計(jì)學(xué)意義(P0.05);妊娠組的治療強(qiáng)度平均為(515.29±136.86)秒/小時(shí),未妊娠組的為(647.92±209.50)秒/小時(shí),差異亦有統(tǒng)計(jì)學(xué)意義(P0.05)。而兩組患者的孕產(chǎn)史及肌瘤的數(shù)目、大小、位置差別無統(tǒng)計(jì)學(xué)意義(P0.05)。結(jié)論:對子宮肌瘤合并不孕、不良孕產(chǎn)史的患者行子宮肌瘤HIFU治療可改善妊娠結(jié)局。年齡35歲、肌壁間肌瘤致宮腔形態(tài)變形、低消融率、高HIFU治療強(qiáng)度不利于HIFU治療后患者妊娠。
[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 鹵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 鹵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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