■观察高强度聚焦超声(HIFU)联合不同药物治疗对子宫腺肌病的疗效。
■回顾性分析126例接受HIFU联合药物治疗的子宫腺肌病患者。患者接受了两种治疗(DNG)(A组,N=38)或GnRH-a(B组,N=88)HIFU后三个月,并在第三个月末接受左炔诺孕酮宫内缓释系统(LNG-IUS)。使用视觉模拟量表(VAS)和图形失血评估图(PBAC)评分评估症状改善。
■在倾向得分匹配(1:2)之后,A组38例,B组76例,HIFU后VAS和PBAC评分明显改善,但在18个月时,A组的PBAC评分明显高于B组[11.50(1.00,29.50)vs.0.00(0.00,16.50),p<0.01]和24个月[4.00(0.25,27.75)vs.0.00(0.00,12.75),HIFU后p=0.04]。此外,B组患者在HIFU后24个月的子宫体积减少大于A组[51.00(27.00,62.00)vs.30.00(17.00,42.75,p=0.02)]。然而,A组的不良反应低于B组[7(15.79)vs.35(46.05),p<0.01]。两组的复发率差异无统计学意义。
■HIFU联合DNG和LNG-IUS对子宫腺肌病患者是一种安全有效的治疗方法。
UNASSIGNED: To observe the therapeutic efficacy of high-intensity focused ultrasound (HIFU) combined with different pharmacological treatments for adenomyosis.
UNASSIGNED: A total of 126 patients with adenomyosis who underwent HIFU combined with pharmacological treatment were retrospectively reviewed. Patients were treated with either dienogest (DNG) (Group A, N = 38) or GnRH-a (Group B, N = 88) for three months after HIFU, and received levonorgestrel-releasing intrauterine systems (LNG-IUS) at the end of the third month. Visual Analog Scale (VAS) and Pictorial Blood Loss Assessment Chart (PBAC) scores were used for evaluating symptom improvement.
UNASSIGNED: After propensity score matching (1:2), 38 patients were included in Group A and 76 in Group B. All patients showed significant improvement in VAS and PBAC scores after HIFU, but the PBAC score of Group A was significantly higher than that of patients in Group B at 18 months [11.50 (1.00, 29.50) vs. 0.00 (0.00, 16.50), p < 0.01] and 24 months [4.00 (0.25, 27.75) vs. 0.00 (0.00, 12.75), p = 0.04] after HIFU. Furthermore, patients in Group B had a greater uterine volume reduction at 24 months after HIFU than that of patients in Group A [51.00 (27.00, 62.00) vs. 30.00 (17.00, 42.75, p = 0.02)]. However, the adverse effects in Group A were lower than those in Group B [7 (15.79) vs. 35 (46.05), p < 0.01]. No significant difference was observed in the recurrence rate between the two groups.
UNASSIGNED: HIFU combined with DNG and LNG-IUS is a safe and effective treatment for patients with adenomyosis.