【摘要】：子宮腺肌病是由于子宮內(nèi)膜的腺體和間質(zhì)侵入子宮肌層時(shí)所致，多發(fā)生于育齡期女性，其主要臨床癥狀為經(jīng)量增多、進(jìn)行性痛經(jīng)、繼發(fā)性不孕，發(fā)病率從8.8%～31.0%不等[1]。子宮腺肌病治療方法有傳統(tǒng)的手術(shù)、藥物治療及近年來發(fā)展迅速的非侵入性治療。手術(shù)治療方式包括子宮切除術(shù)、腺肌病病灶切除術(shù)。臨床常用藥物有促性腺激素釋放激素激動(dòng)劑、雄激素類衍生物、孕激素類和米非司酮等。非侵入性治療則為超聲或磁共振引導(dǎo)下高強(qiáng)度聚焦超聲（HIFU）消融治療。 子宮腺肌病所致的經(jīng)量增多、痛經(jīng)等癥狀以及其所引起繼發(fā)性不孕對(duì)育齡期患者的生活質(zhì)量造成重大影響，HIFU作為一項(xiàng)非侵入性治療，已逐漸為醫(yī)生和病人所熟悉，，我們希望通過分析育齡期子宮腺肌病患者HIFU治療后療效隨訪，探討該項(xiàng)技術(shù)對(duì)于緩解由育齡期子宮腺肌病所引起的臨床癥狀的有效性，從而得出HIFU治療育齡期子宮腺肌病的可行性。 磁共振成像(MRI)對(duì)子宮腺肌病的診斷率達(dá)100%，能夠準(zhǔn)確定位病灶部位、范圍[2]，可用于測量子宮與病灶的體積；靶治療區(qū)在HIFU治療后出現(xiàn)的非灌注區(qū)體積也可通過術(shù)后即刻的盆腔增強(qiáng)MRI得以計(jì)算。故而盆腔增強(qiáng)MRI可用于評(píng)價(jià)子宮腺肌病的消融效果。 通過隨訪子宮腺肌病的消融效果及臨床癥狀緩解效果，可以得出HIFU治療該疾病是否有效的結(jié)論，幫助醫(yī)生和患者更好地進(jìn)行選擇適合的治療方式。 目的：回顧性分析HIFU治療育齡期子宮腺肌病癥狀改善情況，評(píng)價(jià)HIFU治療育齡期子宮腺肌病的安全性及有效性。 方法：收集重慶醫(yī)科大學(xué)附屬第一醫(yī)院2010年7月至2012年2月期間診斷為子宮腺肌病且處于育齡期（年齡18~39歲）的49例患者，采用JC型聚焦超聲腫瘤治療系統(tǒng)進(jìn)行治療，以實(shí)時(shí)超聲灰度改變即刻評(píng)價(jià)治療效果；術(shù)后以盆腔增強(qiáng)MRI評(píng)價(jià)HIFU消融情況；并于HIFU治療后1、3、6、12、24個(gè)月進(jìn)行隨訪，評(píng)價(jià)患者痛經(jīng)癥狀及月經(jīng)量改善情況；根據(jù)國際介入放射治療協(xié)會(huì)制定的SIR分類法評(píng)價(jià)治療的安全性。 結(jié)果：49例患者均完成HIFU治療，治療過程中監(jiān)控超聲評(píng)價(jià)，79.6%有團(tuán)塊狀灰度變化；HIFU治療后增強(qiáng)MRI計(jì)算腺肌病病灶平均消融率為（76.6±10.1）%；治療后1、3、6、12、24個(gè)月，月經(jīng)量增多緩解有效率分別為63.3%、65.7%、67.9%、77.8%、80.0%；痛經(jīng)癥狀緩解有效率分別為91.1%、91.0%、93.0%、92.7%、75.0%；所有病例均無嚴(yán)重不良反應(yīng)發(fā)生，SIR分類A級(jí)41例，B級(jí)5例，C~F級(jí)0例；8例治療后3月到2年內(nèi)懷孕，其中5例順利產(chǎn)子。 結(jié)論：HIFU治療育齡期子宮腺肌病安全有效。
[Abstract]:Adenomyosis is caused by the invasion of endometrial glands and stroma into the myometrium and occurs mostly in women of childbearing age. Its main clinical symptoms are increased menstrual volume, progressive dysmenorrhea, secondary infertility, the incidence of which ranges from 8.81.0% to 31.0% [1]. The treatment methods of adenomyosis include traditional surgery, drug therapy and non-invasive treatment which has developed rapidly in recent years. Surgical treatment includes hysterectomy, adenomyosis focus resection. Commonly used drugs are gonadotropin releasing hormone agonists androgen derivatives progesterone and mifepristone. Non-invasive treatment was guided by ultrasound or magnetic resonance-guided high-intensity focused ultrasound (HIFU) ablation. The increased amount of menstruation caused by adenomyosis, dysmenorrhea and its secondary infertility have had a significant impact on the quality of life of patients of childbearing age. As a non-invasive treatment, HIFU has gradually become familiar to doctors and patients. We hope to investigate the efficacy of HIFU in relieving the clinical symptoms caused by adenomyosis of childbearing age by analyzing the effect of HIFU treatment on patients with adenomyosis of childbearing age. The feasibility of HIFU in the treatment of adenomyosis at childbearing age was obtained. The diagnostic rate of magnetic resonance imaging (MRI) for adenomyosis is 100, and it can accurately locate the location of the lesion [2], which can be used to measure the volume of uterus and lesion. The volume of non-perfusion area in target treatment area after HIFU treatment can also be calculated by pelvic enhanced MRI immediately after operation. Therefore, enhanced pelvic MRI can be used to evaluate the ablation effect of adenomyosis. By following up the ablation effect of adenomyosis and the relief effect of clinical symptoms, we can draw the conclusion that HIFU is effective in the treatment of this disease, and help doctors and patients to choose the appropriate treatment better. Objective: to evaluate the safety and efficacy of HIFU in the treatment of reproductive adenomyosis. Methods: 49 patients with adenomyosis diagnosed in the first affiliated Hospital of Chongqing Medical University from July 2010 to February 2012 were treated with JC focused ultrasound tumor therapy system. The effect of HIFU ablation was evaluated immediately by real-time ultrasound gray scale change, the ablation of HIFU was evaluated by pelvic enhanced MRI, and the symptoms of dysmenorrhea and the improvement of menstrual volume were evaluated at 12 and 24 months after HIFU treatment. Safety was evaluated according to Sir classification developed by the International Association for Interventional radiotherapy. Results all 49 cases of adenomyosis were treated with HIFU. The mean ablation rate of adenomyosis was (76.6 鹵10.1) calculated by enhanced MRI after HIFU treatment, and the mean ablation rate was (76.6 鹵10.1) after HIFU treatment, and 612,12 months after treatment, 24 months after HIFU treatment. The effective rates for relief of increased menstrual volume were 63.3% and 65.7%, 67.9% and 77.8%, respectively; the effective rates for relief of dysmenorrhea were 91.1% and 91.0%, 93.0%, 92.7% and 75.0%, respectively. There were no serious adverse reactions in all cases. There were 41 cases of grade A and 5 cases of grade C F grade B with severe adverse reactions. 8 cases were pregnant within 3 months to 2 years after treatment. Among them, 5 cases gave birth successfully. Conclusion it is safe and effective to treat adenomyosis of childbearing age with HIFU.
【學(xué)位授予單位】：重慶醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2014
【分類號(hào)】：R711.71

【參考文獻(xiàn)】

相關(guān)期刊論文 前3條

1 張旭賓;李坤寅;鄧高丕;歐陽惠卿;;伴有疼痛的子宮內(nèi)膜異位癥患者生存質(zhì)量初步調(diào)查[J];臨床醫(yī)學(xué);2006年03期

2 劉曉鵬;張永萍;楊榮閣;閆春霞;白繼紅;周桂萍;張翠英;李曉輝;王愛;馮冬青;;不同治療方式對(duì)子宮腺肌病患者性生活及婚姻生活質(zhì)量的影響[J];中國婦幼保健;2012年04期

3 劉麗萍,肖子文,肖雁冰,李發(fā)琪,王智彪,王燕芹,譚紅明;超聲對(duì)高強(qiáng)度聚焦超聲治療的實(shí)時(shí)監(jiān)控研究[J];中華超聲影像學(xué)雜志;2005年03期

本文編號(hào)：2132278