本文選題：高強(qiáng)度聚焦超聲 + 子宮腺肌瘤　； 參考：《新鄉(xiāng)醫(yī)學(xué)院》2017年碩士論文

【摘要】：背景子宮腺肌瘤(adenomyoma)是女性生殖系統(tǒng)的常見的良性腫瘤,是嚴(yán)重影響女性健康的腫瘤。子宮腺肌瘤的發(fā)病率為8.8%-31.0%[1],且發(fā)病率逐漸上升。好發(fā)于30-50歲經(jīng)產(chǎn)婦[2],與子宮肌瘤相比較,子宮腺肌瘤的臨床癥狀遠(yuǎn)遠(yuǎn)重于它。主要的臨床癥狀有進(jìn)行性加重的痛經(jīng),月經(jīng)量的異常,月經(jīng)期的延長等。月經(jīng)量的增多又會(huì)導(dǎo)致貧血,全身乏力,不孕,全身各個(gè)系統(tǒng)的疾病等。子宮腺肌瘤的病理基礎(chǔ)是有功能的子宮內(nèi)膜侵入至子宮肌層,出現(xiàn)子宮肌層的增厚,隨月經(jīng)期出現(xiàn)出血,形成局灶性病灶,逐漸發(fā)展為肌壁間腫瘤,可出現(xiàn)痛經(jīng)等嚴(yán)重癥狀[3-6]。以往治療子宮腺肌瘤的方法創(chuàng)傷較大,現(xiàn)在患者對于治療方式也要求的越來越高,患者想要采用保守的治療方式來保留子宮。高強(qiáng)度聚焦超聲(High Intensity Focused Ultrasound,HIFU)是近年來新型的無創(chuàng)治療的方法,用來治療實(shí)體腫瘤,現(xiàn)逐漸得到廣泛患者的關(guān)注,作為一種保守性的治療方式來治療子宮腺肌瘤[4]。本研究是對比患者在使用高強(qiáng)度聚焦超聲治療前及治療后的子宮腺肌瘤消融的體積、痛經(jīng)的改變、月經(jīng)量的改變及CA125的變化來了解高強(qiáng)度聚焦超聲治療子宮腺肌瘤的有效性。目的研究高強(qiáng)度聚焦超聲治療子宮腺肌瘤的臨床效果。方法選擇的對象為于2014年9月-2016年9月在新鄉(xiāng)醫(yī)學(xué)院第一附屬醫(yī)院治療的患者,診斷子宮腺肌瘤明確,有月經(jīng)量增多及痛經(jīng)癥狀,且有保留子宮愿望的,愿意接受高強(qiáng)度聚焦超聲治療的子宮腺肌瘤患者。治療方法:采用的設(shè)備是重慶海扶(HIFU)技術(shù)有限公司研制聚焦超聲腫瘤治療系統(tǒng),型號(hào)是JC200,對60例(共64個(gè)子宮腺肌瘤)患者在鎮(zhèn)靜鎮(zhèn)痛下進(jìn)行治療,采取俯臥位,操作過程中采用實(shí)時(shí)超聲聲像圖引導(dǎo)。觀察治療后3月及6月的指標(biāo),通過詢問患者臨床癥狀的改變,子宮腺肌瘤在影像檢測下的改變,以及實(shí)驗(yàn)室指標(biāo)CA125的變化,來評(píng)價(jià)高強(qiáng)度聚焦超聲治療子宮腺肌瘤的效果。得到的數(shù)據(jù)使用SPSS 19.0統(tǒng)計(jì)分析,治療前、治療后3個(gè)月及治療后6個(gè)月各觀察指標(biāo),兩兩比較均數(shù)的差異,采用q檢驗(yàn)來統(tǒng)計(jì)分析。結(jié)果1.本研究治療前的臨床資料:子宮腺肌瘤體積大小為34.85±17.89 cm3;痛經(jīng)評(píng)分為4.47±2.04分;以患者治療前的月經(jīng)量為基數(shù)100%,月經(jīng)量表示為100±0%;CA125的值為129.50±142.03 U/ml。在治療后第3個(gè)月的臨床資料:子宮腺肌瘤體積大小為29.27±14.29 cm3;痛經(jīng)評(píng)分為2.98±1.48分;月經(jīng)量為68±12%;CA125的值為111.63±116.01 U/ml。在治療后第6個(gè)月的臨床資料:子宮腺肌瘤體積大小為28.88±11.65 cm3;痛經(jīng)評(píng)分為1.98±1.03分;月經(jīng)量為52±14%;CA125的值為100.72±103.32 U/ml。2.治療前、治療后3月、治療后6月的各觀察指標(biāo)的數(shù)值分別兩兩進(jìn)行比較,采用q檢驗(yàn)來統(tǒng)計(jì)分析�？梢缘贸鲋委熀�3月及治療后6月的子宮腺肌瘤的體積小于治療前(P0.05);痛經(jīng)的評(píng)分較前減小(P0.05),癥狀較前減輕;月經(jīng)量也有顯著的減少(P0.05),CA125的變化(P0.05)。子宮腺肌瘤體積、痛經(jīng)及月經(jīng)量及CA125的差異均有統(tǒng)計(jì)學(xué)意義。3.在選擇的60例患者中,并發(fā)癥出現(xiàn)較少。僅有1例患者出現(xiàn)右下肢麻木癥狀,待使用營養(yǎng)神經(jīng)藥物(VitB1,Vit B12)3個(gè)月后,癥狀消失。有1例皮膚燒灼,半月后癥狀消失。有12例患者在接受高強(qiáng)度聚焦超聲治療后當(dāng)天出現(xiàn)下腹部疼痛癥狀,經(jīng)藥物鎮(zhèn)痛后,癥狀緩解,1周左右疼痛癥狀完全消失。結(jié)論高強(qiáng)度聚焦超聲治療子宮腺肌瘤的效果明顯,可有效的減小子宮腺肌瘤的體積、改善痛經(jīng)癥狀,減少月經(jīng)量并降低CA125的值。治療后并發(fā)癥較少,是患者想要采用保守治療的方法的可行的選擇。
[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.

【學(xué)位授予單位】：新鄉(xiāng)醫(yī)學(xué)院
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R737.33

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