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目的探讨超声消融子宫腺肌病的有效性和安全性。方法对重庆医科大学附属第一医院2007年3月至2008年9月期间78例以痛经为主伴有或不伴有经量增多的子宫腺肌病患者行超声消融治疗,评价患者对治疗的耐受性,定期随访治疗后症状变化,记录治疗后6个月内不良反应发生情况,增强MRI评价治疗前后病灶凝固性坏死情况。结果78例患者中疼痛评分4分以下者占84.6%,其中1例因血压升高不能缓解而终止治疗;具有完整随访资料的患者69例,随访时间(11.9±6.4)个月。治疗前后月经量评分和痛经评分降低,差异具有显著性(P<0.05);62例痛经症状得到不同程度缓解,总有效率89.9%;69例患者中22例(32%)发生不良反应,其中4例发生2种以上。27例次数不良反应中23例(85.1%)为SIRA类;4例(14.8%)SIRB类不良反应对症处理后均恢复;全部病例均无严重的不良事件发生,亦无住院时间延长或再次入院。60例增强MRI可见无灌注区域,凝固性坏死发生率为87.0%,无灌注区大小和病灶部位与不良反应发生均无相关性(P>0.05)。结论超声消融是一种安全有效的治疗方式,可成为子宫腺肌病可供选择的一种新型无创治疗方式。
Objective To investigate the effectiveness and safety of ultrasound in the treatment of adenomyosis. Methods From March 2007 to September 2008, 78 cases of adenomyosis with or without dysmenorrhea were treated with ultrasound ablation in the First Affiliated Hospital of Chongqing Medical University from March 2007 to September 2008, Tolerance, regular follow-up after treatment of symptoms, record the adverse reactions within 6 months after treatment, enhanced MRI evaluation of coagulation and necrosis lesions before and after treatment. Results Among 78 patients, 84.6% had pain scores less than 4, of which 1 patient discontinued treatment due to elevated blood pressure. Sixty-nine patients with complete follow-up data were followed up for 11.9 ± 6.4 months. The menstrual volume and dysmenorrhea scores decreased before and after treatment (P <0.05), 62 cases of dysmenorrhea were relieved to some extent, the total effective rate was 89.9%, and 22 of 69 cases (32%) had adverse reactions, of which, 4 cases occurred in two or more. Twenty-seven (85.1%) of the 27 adverse reactions were SIRA; 4 (14.8%) SIRB-type adverse reactions recovered after symptomatic treatment; no serious adverse events occurred in all the cases, nor prolonged hospital stay or re-admission . There were no perfusion regions in 60 patients with enhanced MRI, and the incidence of coagulation necrosis was 87.0%. There was no correlation between the size of non perfusion region and the location of lesion with adverse reactions (P> 0.05). Conclusion Ultrasound ablation is a safe and effective treatment, which can be a new non-invasive treatment for adenomyosis.