本文選題：高強(qiáng)度聚焦超聲(HIFU)子宮肌瘤消融術(shù) + 子宮肌瘤剔除術(shù)��； 參考：《河北醫(yī)科大學(xué)》2017年碩士論文

【摘要】：目的:比較高強(qiáng)度聚焦超聲子宮肌瘤消融術(shù)(HIFU)與子宮肌瘤剔除術(shù)術(shù)后肌瘤復(fù)發(fā)及妊娠結(jié)局;探討高強(qiáng)度聚焦超聲子宮肌瘤消融術(shù)用于治療子宮肌瘤的可行性和術(shù)后妊娠情況。方法:選取2012年7月至2014年5月于河北醫(yī)科大學(xué)第二醫(yī)院接受治療且有生育要求的符合納入標(biāo)準(zhǔn)的子宮肌瘤患者。本研究經(jīng)腔內(nèi)彩色多普勒超聲檢查或MRI檢查證實有子宮肌瘤且有生育要求的患者126例,在治療后隨訪過程中有18例患者失訪,最后調(diào)查結(jié)束共計108例患者納入研究,分為HIFU組和手術(shù)組,其中HIFU組56例,手術(shù)組52例。海扶組給予HIFU子宮肌瘤消融治療;手術(shù)組給予子宮肌瘤剔除術(shù)治療;觀察兩種術(shù)式后患者3個月、6個月、12個月、18個月妊娠情況,同時對妊娠結(jié)局進(jìn)行評估。在隨訪期內(nèi)對兩組患者的術(shù)后復(fù)發(fā)、妊娠、分娩等情況進(jìn)行對比觀察。采用SPSS19.0統(tǒng)計軟件進(jìn)行數(shù)據(jù)分析,計數(shù)資料比較采用t檢驗,以P0.05表示差異具有統(tǒng)計學(xué)意義。結(jié)果:1本研究經(jīng)腔內(nèi)彩色多普勒超聲檢查或MRI檢查證實有子宮肌瘤且有生育要求的患者108例,其中海扶組56例,手術(shù)組52例。其中海扶組年齡在18-44歲之間,平均年齡為31.45±6.163歲,手術(shù)組年齡范圍為19-45歲,平均年齡為32.62±5.752歲,兩者無顯著性差異;且兩組患者在年齡構(gòu)成、身高、體重、結(jié)婚情況、孕次、產(chǎn)次、術(shù)前伴痛經(jīng)、術(shù)前伴小腹疼痛、術(shù)前伴CA125異常等方面都沒有顯著性差異(P0.05);2術(shù)后18個月內(nèi)HIFU組有7名患者發(fā)生復(fù)發(fā)、手術(shù)組有6名患者發(fā)生復(fù)發(fā),復(fù)發(fā)率分別為12.5%、11.5%,兩組復(fù)發(fā)率比較,無顯著性差異(P0.05);3術(shù)后18個月內(nèi)HIFU組有18名妊娠者、手術(shù)組有17名妊娠者,妊娠率分別為32.14%、32.69%,兩組妊娠率比較,無顯著性差異(P0.05);4對兩組患者的術(shù)后受孕時間進(jìn)行比較分析,HIFU組和手術(shù)組的妊娠時間分別為4.53±2.52月、12.62±7.43月,HIFU組平均術(shù)后受孕時間顯著低于手術(shù)組,兩組數(shù)據(jù)具有顯著性差異(P0.05);5兩組患者的妊娠年齡比較,兩組患者的妊娠年齡以25-34歲比例最高,分別為66.67%和63.15%,而40歲以上者妊娠比例較低,分別為11.11%和5.88%;6兩組患者18個月內(nèi)共妊娠35例,其中HIFU組妊娠人數(shù)18例,手術(shù)組妊娠人數(shù)17例。妊娠后HIFU組和手術(shù)組分別有2例和1例患者行人工流產(chǎn)術(shù),HIFU組有1例患者發(fā)生胚胎停育,手術(shù)組有2例發(fā)生胚胎停育。HIFU組順產(chǎn)9例,剖宮產(chǎn)6例,而手術(shù)組順產(chǎn)3例,剖宮產(chǎn)11例,HIFU組與手術(shù)組妊娠期和分娩期均無子宮破裂發(fā)生,HIFU組術(shù)后剖宮產(chǎn)率明顯低于手術(shù)組,兩組數(shù)據(jù)具有顯著性差異(P0.05);7按照子宮肌瘤的類型分組(FIGO分型),不同類型子宮肌瘤術(shù)后妊娠情況如下: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%)。不同類型子宮肌瘤術(shù)后妊娠情況比較,差異無統(tǒng)計學(xué)意義(P0.05)。結(jié)論:HIFU治療子宮肌瘤是一種安全有效的非侵入性治療方法。對有生育要求的患者經(jīng)HIFU治療子宮肌瘤后,術(shù)后受孕時間顯著縮短,HIFU治療子宮肌瘤具有一定應(yīng)用推廣價值。
[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.
【學(xué)位授予單位】：河北醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R737.33

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