目的:本试验旨在探讨不同治疗方法对子宫腺肌病患者临床疗效及生育结局的影响。
方法:总共,将140例子宫腺肌病患者随机分为A组(腹腔镜手术),B组(腹腔镜手术联合促性腺激素释放激素类似物[GnRH-a]),C组(超声引导下经皮射频消融),和D组(超声引导下经皮射频消融联合GnRH-a)。手术后的第3天,B组和D组患者皮下注射GnRH-a(注射用醋酸亮丙瑞林SR)3.75mg/次,每4周一次,共3个月。比较4组的治疗效果,包括月经量,痛经评分,子宫体积,临床疗效,黄体生成素(LH),雌二醇(E2),和卵泡刺激素(FSH)水平,CA125水平,复发,怀孕状态,和妊娠结局。
结果:治疗后,4组月经量减少,痛经,视觉模拟量表(VAS)评分,LH,FSH,E2和CA125水平降低,子宫体积减少。月经量,VAS评分,LH水平,FSH,B组患者E2、CA125和子宫体积均减少,C,D与A组相比,D组总有效率为100.00%,高于A组(71.43%),B组(80.00%),C组(82.86%)。停药一年后,月经过多的复发,痛经,子宫增大,D组CA125超标明显低于A组,B和C,B、C组复发率明显低于A组(P<0.05)。与A组相比,B,C,D组妊娠率较高,自然妊娠率,体外受精-胚胎移植率较低(P<0.05),但在妊娠结局上没有显著差异。
结论:超声引导下经皮射频消融术联合醋酸亮丙瑞林治疗子宫腺肌病有效。可以有效缓解临床症状,保护术后卵巢功能,降低复发率,缓解疼痛,提高生活质量。
OBJECTIVE: This trial was to investigate the effect of different treatment methods on the clinical efficacy and fertility outcome of patients with adenomyosis.
METHODS: In total, 140 patients with adenomyosis were evenly and randomly allocated into group A (laparoscopic surgery), group B (laparoscopic surgery combined with gonadotropin-releasing hormone analogs [GnRH-a]), group C (ultrasound-guided percutaneous radiofrequency ablation), and group D (ultrasound-guided percutaneous radiofrequency ablation combined with GnRH-a). On the 3rd day after surgery, patients in group B and group D were subcutaneously injected with GnRH-a (Leuprorelin Acetate SR for Injection) at 3.75 mg/time, once every 4 weeks, for a total of 3 months. The therapeutic effects of the 4 groups were compared, including menstrual volume, dysmenorrhea score, uterine volume, clinical efficacy, luteinizing hormone (LH), estradiol (E2), and follicle-stimulating hormone (FSH) levels, CA125 levels, recurrence, pregnancy status, and pregnancy outcomes.
RESULTS: After treatment, the menstrual volume of 4 groups was lowered, dysmenorrhea, Visual Analog Scale (VAS) score, LH, FSH, E2, and CA125 levels were reduced, and uterine volume was decreased. The menstrual volume, VAS score, levels of LH, FSH, E2, and CA125, and uterine volume were reduced in groups B, C, and D compared with group A, and the decrease was more significant in group D. The total effective rate of group D was 100.00%, which was higher than that of group A (71.43%), group B (80.00%), and group C (82.86%). After one year of drug withdrawal, the recurrence of hypermenorrhea, dysmenorrhea, uterine enlargement, and excessive CA125 in group D was significantly lower than that in groups A, B and C, and the recurrence in groups B and C was significantly lower than that in group A (P < 0.05). Compared with groups A, B, and C, group D had a higher pregnancy rate, natural pregnancy rate, and lower in vitro fertilization-embryo transfer rate (P < 0.05), but showed no significant difference in pregnancy outcomes.
CONCLUSIONS: Ultrasound-guided percutaneous radiofrequency ablation combined with Leuprorelin Acetate is effective in the treatment of adenomyosis, which can effectively relieve clinical symptoms, protect postoperative ovarian function, reduce recurrence rate, alleviate pain, and improve quality of life.