【摘要】：目的 1、評估超聲引導經(jīng)皮微波消融（Percutaneous microwave abltion, PMWA）治療癥狀性子宮腺肌病的安全性；2、對經(jīng)PMWA治療后，癥狀性子宮腺肌病患者臨床療效的改善進行探討。 材料與方法 1、安全性研究：185例癥狀性子宮腺肌病患者接受PMWA治療，記錄消融后患者可能出現(xiàn)的相關不良反應，并根據(jù)國際介入放射治療協(xié)會制定的SCVIR分類法對其進行評價。對患者3、6、9、12個月血清雌二醇（Estradiol, E2）及卵泡刺激素（Follicle-Stimulating Hormone, FSH）水平進行統(tǒng)計分析，同時記錄患者月經(jīng)、妊娠、更年期相關癥狀等，探討治療對患者卵巢及子宮內(nèi)膜功能的影響。 2、療效研究:對經(jīng)PMWA治療的癥狀性子宮腺肌病患者消融后3、6、9、12月的痛經(jīng)評分、子宮體積、貧血患者血紅蛋白改善及子宮肌瘤癥狀及與健康相關生活質(zhì)量（The Uterine Fibroid Symptom and Quality of Life, UFS-QOL）問卷得分進行統(tǒng)計分析，并進一步對彌漫性及局限性子宮腺肌病患者PMWA治療后改善進行分類討論。同時，記錄患者消融前及消融后3、6、9、12個月血清癌抗原125（cancerantigen125，CA125）及泌乳素（Prolactin, PRL）水平，以進一步評價消融效果。 結(jié)果 1、安全性研究：消融后患者一般情況良好，SCVIR分類中除1名患者為C類，其余均為A或B類。患者主要不良反應包括：陰道流液，多為淡粉色且1月內(nèi)消失，1例為血性，并于治療后2天出現(xiàn)高熱，再次入院給予止血、縮宮等對癥治療后好轉(zhuǎn)；治療區(qū)疼痛，92例于消融后6小時內(nèi)出現(xiàn)，給予一次止痛藥物后癥狀消失；發(fā)熱，共14例，1例為中等熱度，其余為低熱，平均體溫37.5±0.2℃；鏡下血尿，共18例于治療后4小時內(nèi)出現(xiàn)，考慮為置入導尿管刺激所致，未予特殊處理，2-4日后復查尿常規(guī)正常；壞死組織自然排出，，共23例于治療后1-12個月出現(xiàn)�；颊呦谇昂驟2及FSH定量比較差異均無統(tǒng)計學意義（p＞0.05）。1例患者出現(xiàn)宮腔黏連，給予黏連分解術(shù)后月經(jīng)正常來潮，其余患者月經(jīng)周期及經(jīng)期持續(xù)時間正常。消融后共有5例患者6次自然受孕，人工流產(chǎn)5次，待產(chǎn)1例。 2、療效研究：復查各時期痛經(jīng)評分、子宮體積、貧血患者血紅蛋白定量及UFS-QOL問卷得分情況與治療前相比均明顯好轉(zhuǎn)（p＜0.05）。治療后彌漫性與局限性子宮腺肌病相比，上述各項指標差異均無明顯統(tǒng)計學意義（p＞0.05）。治療后患者血清CA125及PRL均較治療前明顯下降（p＜0.05），進一步將二者與腺肌病主要癥狀改善情況進行相關分析，結(jié)果顯示：CA125與痛經(jīng)、子宮體積變化正相關（相關系數(shù)分別為0.374、0.440，p＜0.05）；而PRL與上述三項變化未呈現(xiàn)出明顯的統(tǒng)計學相關性（p＞0.05）；同時，CA125與PRL的相關性無明顯統(tǒng)計學意義（p＞0.05）。 結(jié)論 1、安全性研究：（1）PMWA治療癥狀性子宮腺肌病，消融后患者無子宮周圍臟器器質(zhì)性損害，但為保證消融安全性，治療中仍需密切監(jiān)測熱場高回聲范圍。（2）超聲引導經(jīng)皮微波消融治療子宮腺肌病技術(shù)對患者卵巢及內(nèi)膜功能均無明顯影響�；颊呷杂性俅稳焉锟赡�，但對于有強烈妊娠要求者，仍需慎重。 2、療效研究：（1）PMWA治療子宮腺肌病能明顯縮小子宮體積，減輕痛經(jīng)、貧血等癥狀，提高患者生活質(zhì)量。（2）彌漫性子宮腺肌病與局限性子宮腺肌病的PMWA治療均可得到滿意臨床療效。（3）PMWA治療子宮腺肌病患者血清CA125及PRL顯著下降，且CA125的變化與子宮體積及痛經(jīng)情況變化間存在相關性。
[Abstract]:objective
1. To evaluate the safety of ultrasound-guided percutaneous microwave ablation (PMWA) in the treatment of symptomatic adenomyosis; 2. To explore the improvement of clinical efficacy in patients with symptomatic adenomyosis after PMWA treatment.
Materials and methods
1. Safety study: 185 patients with symptomatic adenomyosis were treated with PMWA. Possible adverse reactions after ablation were recorded and evaluated according to the SCVIR classification established by the International Association for Interventional Radiotherapy. Ng Hormone, FSH) levels were statistically analyzed, and the symptoms related to menstruation, pregnancy and menopause were recorded to explore the effects of treatment on ovarian and endometrial function.
2. Efficacy study: The dysmenorrhea score, uterine volume, hemoglobin improvement, uterine fibroids symptoms and the health-related quality of life (UFS-QOL) questionnaire scores of symptomatic adenomyosis patients treated with PMWA at 3, 6, 9, and 12 months after ablation were statistically analyzed and further analyzed. The improvement of PMWA in patients with diffuse and localized adenomyosis was discussed. The serum levels of cancer antigen 125 (CA125) and prolactin (PRL) were recorded before and 3,6,9,12 months after ablation to further evaluate the ablation effect.
Result
1. Safety study: After ablation, the general condition of patients is good, except one patient in SCVIR classification for C, the rest are A or B. The main adverse reactions include: vaginal bleeding, mostly pale pink and disappeared within 1 month, 1 case of hemorrhagic, and 2 days after the treatment of high fever, re-admission to the hospital for hemostasis, uterine contraction and other symptomatic treatment for improvement; Regional pain occurred in 92 cases within 6 hours after ablation, and symptoms disappeared after treatment with a painkiller; fever occurred in 14 cases, moderate fever in 1 case, and low fever in the rest, with an average body temperature of 37.5 [0.2]; microscopic hematuria occurred in 18 cases within 4 hours after treatment, and was considered to be caused by catheter stimulation without special treatment. There was no significant difference in the amount of E2 and FSH between before and after ablation (p > 0.05). One patient developed intrauterine adhesions and normal menstruation after decomposition of adhesions. The rest had normal menstrual cycle and duration. Natural conception, artificial abortion 5 times, 1 cases of labor.
2. Efficacy study: The dysmenorrhea score, uterine volume, hemoglobin quantification and UFS-QOL score of anemia patients were significantly improved after treatment (p < 0.05). There was no significant difference between diffuse and localized adenomyosis after treatment (p > 0.05). The results showed that CA125 was positively correlated with dysmenorrhea and uterine volume changes (correlation coefficients were 0.374, 0.440, P < 0.05), while PRL was not significantly correlated with the above three changes (p > 0.05). At the same time, the correlation between CA125 and PRL was not statistically significant (P > 0.05).
conclusion
1. Safety study: (1) PMWA treatment of symptomatic adenomyosis, ablation of patients without periuterine organs damage, but to ensure the safety of ablation, the treatment still needs to closely monitor the range of high echo in the thermal field. (2) ultrasound-guided percutaneous microwave ablation of adenomyosis in patients with ovarian and endometrial function were not significantly affected. Pregnant women may still have another pregnancy, but caution is needed for those who have strong pregnancy requirements.
2. Efficacy study: (1) PMWA treatment of adenomyosis can significantly reduce uterine volume, alleviate dysmenorrhea, anemia and other symptoms, improve the quality of life of patients. (2) Diffuse adenomyosis and localized adenomyosis PMWA treatment can be satisfied with clinical efficacy. (3) PMWA treatment of adenomyosis patients serum CA125 and PRL significantly decreased, and CA125. There was a correlation between the changes of uterine volume and dysmenorrhea.
【學位授予單位】：中國人民解放軍醫(yī)學院
【學位級別】：碩士
【學位授予年份】：2014
【分類號】：R711.71;R445.1

【共引文獻】

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4 李

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