高强度聚焦超声治疗有生育要求子宫腺肌病患者的妊娠结局
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摘要
目的:探讨有生育要求的子宫腺肌病(AM)患者接受高强度聚焦超声(HIFU)治疗后的妊娠结局。方法:回顾分析2012年9月至2017年9月在中南大学湘雅三医院接受HIFU治疗的有生育要求的76例AM患者的临床资料。分析患者治疗后症状变化及妊娠结局,并与接受保守手术治疗的研究进行比较。结果:76例患者经HIFU治疗后,56例58次妊娠(妊娠组),中位妊娠时间为治疗后24个月,其中28例(30次)足月分娩,2例早产,20例自然流产,5例人工流产,1例异位妊娠。未妊娠组20例。患者治疗后月经及痛经症状较治疗前均有显著改善(P<0.05)。19例不孕症患者经治疗后,15例成功受孕,妊娠率78.9%。有自然流产史的14例患者经治疗后,11例受孕,7例已足月分娩。与国外学者的保守手术临床研究比较,HIFU治疗后的妊娠率及足月分娩率均显著增高,差异有统计学意义(P均<0.05),可选择自然分娩,无严重并发症发生。结论:HIFU用于治疗有生育要求的AM患者,可改善患者的妊娠结局,降低自然流产率,分娩方式可选择自然分娩,同时不增加妊娠及分娩时并发症发生率,是一种有效的治疗方式。
Objective:To investigate the pregnancy outcomes of adenomyosis patients with reproductive requirements after accepting high intensity focused ultrasound(HIFU) ablation therapy.Methods:From Sep.2012 to Sep.2017,76 patients with adenomyosis who wish to get pregnancies were treated by HIFU in the Third Xiangya Hospital.The changes of the postoperative symptoms and the pregnancy outcomes were summarized and analyzed,and compared with the patients who underwent the conservative surgery.Results:In the 76 patients who accepted HIFU therapy,56 patients had 58 gestations(The gestation group).The median interval of the pregnancy was 24 months after the therapy.There were 28 patients had 30 full-term delivery,2 patients had premature birth,20 patients suffered from spontaneous abortion,5 patients selected artificial abortion,and one was ectopic gestation.The non-pregnancy group had 20 patients.After the HIFU treatment,the menstruation condition score and pain score decreased significantly(P<0.05).In our research,15 cases of 19 infertility patients get pregnant after the HIFU ablation,the pregnancy rate was 78.9%.Among 14 patients who suffered spontaneous abortion before,11 cases became pregnant after the treatment and 7 cases already had term birth.Compared with the foreign clinical research of conservative surgery,patients in our study had higher pregnancy rate and term birth rate(P<0.05),and had the chance to select vaginal delivery with no serious complications.Conclusion:HIFU ablation treatment is an effective therapy for the adenomyosis patients who have reproductive requirements.It may increase the prevalence of pregnancy,reduce the spontaneous abortion rate and may not increase the complications during pregnancy and vaginal delivery.
Objective:To investigate the pregnancy outcomes of adenomyosis patients with reproductive requirements after accepting high intensity focused ultrasound(HIFU) ablation therapy.Methods:From Sep.2012 to Sep.2017,76 patients with adenomyosis who wish to get pregnancies were treated by HIFU in the Third Xiangya Hospital.The changes of the postoperative symptoms and the pregnancy outcomes were summarized and analyzed,and compared with the patients who underwent the conservative surgery.Results:In the 76 patients who accepted HIFU therapy,56 patients had 58 gestations(The gestation group).The median interval of the pregnancy was 24 months after the therapy.There were 28 patients had 30 full-term delivery,2 patients had premature birth,20 patients suffered from spontaneous abortion,5 patients selected artificial abortion,and one was ectopic gestation.The non-pregnancy group had 20 patients.After the HIFU treatment,the menstruation condition score and pain score decreased significantly(P<0.05).In our research,15 cases of 19 infertility patients get pregnant after the HIFU ablation,the pregnancy rate was 78.9%.Among 14 patients who suffered spontaneous abortion before,11 cases became pregnant after the treatment and 7 cases already had term birth.Compared with the foreign clinical research of conservative surgery,patients in our study had higher pregnancy rate and term birth rate(P<0.05),and had the chance to select vaginal delivery with no serious complications.Conclusion:HIFU ablation treatment is an effective therapy for the adenomyosis patients who have reproductive requirements.It may increase the prevalence of pregnancy,reduce the spontaneous abortion rate and may not increase the complications during pregnancy and vaginal delivery.
引文
[1] 陈芳.高强度聚焦超声在子宫腺肌病治疗中的应用[J].医学影像学杂志,2018,28(7):1218-1224
[2] Younes G,Tulandi T.Effects of adenomyosis on in vitro fertilization treatment outcomes:a meta-analysis[J].Fertil Steril,2017,108(3):483-490
[3] Devlieger R,D'Hooghe T,Timmerman D.Uterine adenomyosis in the infertility clinic[J].Hum Reprod Update,2003,9(2):139-147
[4] Salim R,Riris S,Saab W,et al.Adenomyosis reduces pregnancy rates in infertile women undergoing IVF[J].Reprod Biomed Online,2012,25(3):273-277
[5] Ferrari F,Arrigoni F,Miccoli A,et al.Effectiveness of magnetic resonance-guided focused ultrasound surgery (MRgFUS) in the uterine adenomyosis treatment:technical approach and MRI evaluation[J].Radiol Med,2016,121(2):153-161
[6] 中华医学会妇产科学分会子宫内膜异位症协作组.子宫内膜异位症的诊治指南[J].中华妇产科杂志,2015,50(3):161-169
[7] Zhang L,Rao F,Setzen R.High intensity focused ultrasound for the treatment of adenomyosis:selection criteria,efficacy,safety and fertility[J].Acta Obstet Gynecol Scand,2017,96(6):707-714
[8] Zhou M,Chen JY,Tang LD,et al.Ultrasound-guided high-intensity focused ultrasound ablation for adenomyosis:the clinical experience of a single center[J].Fertil Steril,2011,95(3):900-905
[9] 秦瑞英,王艳敏,华彩虹,等.超声造影评价高强度聚焦超声治疗子宫腺肌病效果[J].重庆医学,2014,43(21):2722-2724
[10] Saremi A,Bahrami H,Salehian P,et al.Treatment of adenomyomectomy in women with severe uterine adenomyosis using a novel technique[J].Reprod Biomed Online,2014,28(6):753-760
[11] Cheung VY.Current status of high-intensity focused ultrasound for the management of uterine adenomyosis.Ultrasonography[J].2017,36(2):95-102
[12] 李亚里.子宫腺肌病不孕患者的病因及治疗选择[J].中国实用妇科与产科杂志,2009,25(9):662-665
[13] 郎景和,崔恒,戴毅,等.2015年子宫内膜异位症的诊治指南专家解读[J].中华妇产科杂志,2017,52(12):857-861
[14] 罗爽,何敏,张炼.超声消融子宫腺肌瘤后患者妊娠情况分析[J].重庆医学,2014,43(4):454-458
[15] Schwartz D,Mayaux MJ.Female fecundity as a function of age:results of artificial insemination in 2193 nulliparous women with azoospermic husbands.Federation CECOS[J].N Engl J Med,1982,306(7):404-406
[16] 李莉,乔杰,王海燕.不明原因复发性流产免疫学发病机制的研究进展[J].中华生殖与避孕杂志,2017,37(2):160-165
[17] 张彭南,朱杰,薛晓红.腹腔镜下子宫腺肌病病灶切除术治疗子宫腺肌病的临床分析[J].现代妇产科进展,2015,24(2):135-137
[18] 冯玉洁,陈锦云,胡亮,等.弥漫型和局限型子宫腺肌病超声消融安全性对比分析[J].中国介入影像与治疗学,2016,13(6):342-347
[19] Wang CJ,Yuen LT,Chang SD,et al.Use of laparoscopic cytoreductive surgery to treat infertile women with localized adenomyosis[J].Fertil Steril,2006,86(2):462.e5-8
[20] Kishi Y,Yabuta M,Taniguchi F.Who will benefit from uterus-sparing surgery in adenomyosis-associated subfertility?[J].Fertil Steril,2014,102(3):802-807
[21] 宋晗,周应芳.子宫腺肌病病灶挖除术与孕期子宫破裂[J].实用妇产科杂志,2018,34(1):6-8
[22] Fan TY,Zhang L,Chen WZ,et al.Feasibility of MRI-guided high intensity focused ultrasound treatment for adenomyosis[J].Eur J Radiol,2012,81(11):3624-3630
[23] Hashimoto A,Iriyama T,Sayama S,et al.Adenomyosis and adverse perinatal outcomes:increased risk of second trimester miscarriage,preeclampsia,and placental malposition[J].J Matern Fetal Neonatal Med,2018,31(3):364-369
[2] Younes G,Tulandi T.Effects of adenomyosis on in vitro fertilization treatment outcomes:a meta-analysis[J].Fertil Steril,2017,108(3):483-490
[3] Devlieger R,D'Hooghe T,Timmerman D.Uterine adenomyosis in the infertility clinic[J].Hum Reprod Update,2003,9(2):139-147
[4] Salim R,Riris S,Saab W,et al.Adenomyosis reduces pregnancy rates in infertile women undergoing IVF[J].Reprod Biomed Online,2012,25(3):273-277
[5] Ferrari F,Arrigoni F,Miccoli A,et al.Effectiveness of magnetic resonance-guided focused ultrasound surgery (MRgFUS) in the uterine adenomyosis treatment:technical approach and MRI evaluation[J].Radiol Med,2016,121(2):153-161
[6] 中华医学会妇产科学分会子宫内膜异位症协作组.子宫内膜异位症的诊治指南[J].中华妇产科杂志,2015,50(3):161-169
[7] Zhang L,Rao F,Setzen R.High intensity focused ultrasound for the treatment of adenomyosis:selection criteria,efficacy,safety and fertility[J].Acta Obstet Gynecol Scand,2017,96(6):707-714
[8] Zhou M,Chen JY,Tang LD,et al.Ultrasound-guided high-intensity focused ultrasound ablation for adenomyosis:the clinical experience of a single center[J].Fertil Steril,2011,95(3):900-905
[9] 秦瑞英,王艳敏,华彩虹,等.超声造影评价高强度聚焦超声治疗子宫腺肌病效果[J].重庆医学,2014,43(21):2722-2724
[10] Saremi A,Bahrami H,Salehian P,et al.Treatment of adenomyomectomy in women with severe uterine adenomyosis using a novel technique[J].Reprod Biomed Online,2014,28(6):753-760
[11] Cheung VY.Current status of high-intensity focused ultrasound for the management of uterine adenomyosis.Ultrasonography[J].2017,36(2):95-102
[12] 李亚里.子宫腺肌病不孕患者的病因及治疗选择[J].中国实用妇科与产科杂志,2009,25(9):662-665
[13] 郎景和,崔恒,戴毅,等.2015年子宫内膜异位症的诊治指南专家解读[J].中华妇产科杂志,2017,52(12):857-861
[14] 罗爽,何敏,张炼.超声消融子宫腺肌瘤后患者妊娠情况分析[J].重庆医学,2014,43(4):454-458
[15] Schwartz D,Mayaux MJ.Female fecundity as a function of age:results of artificial insemination in 2193 nulliparous women with azoospermic husbands.Federation CECOS[J].N Engl J Med,1982,306(7):404-406
[16] 李莉,乔杰,王海燕.不明原因复发性流产免疫学发病机制的研究进展[J].中华生殖与避孕杂志,2017,37(2):160-165
[17] 张彭南,朱杰,薛晓红.腹腔镜下子宫腺肌病病灶切除术治疗子宫腺肌病的临床分析[J].现代妇产科进展,2015,24(2):135-137
[18] 冯玉洁,陈锦云,胡亮,等.弥漫型和局限型子宫腺肌病超声消融安全性对比分析[J].中国介入影像与治疗学,2016,13(6):342-347
[19] Wang CJ,Yuen LT,Chang SD,et al.Use of laparoscopic cytoreductive surgery to treat infertile women with localized adenomyosis[J].Fertil Steril,2006,86(2):462.e5-8
[20] Kishi Y,Yabuta M,Taniguchi F.Who will benefit from uterus-sparing surgery in adenomyosis-associated subfertility?[J].Fertil Steril,2014,102(3):802-807
[21] 宋晗,周应芳.子宫腺肌病病灶挖除术与孕期子宫破裂[J].实用妇产科杂志,2018,34(1):6-8
[22] Fan TY,Zhang L,Chen WZ,et al.Feasibility of MRI-guided high intensity focused ultrasound treatment for adenomyosis[J].Eur J Radiol,2012,81(11):3624-3630
[23] Hashimoto A,Iriyama T,Sayama S,et al.Adenomyosis and adverse perinatal outcomes:increased risk of second trimester miscarriage,preeclampsia,and placental malposition[J].J Matern Fetal Neonatal Med,2018,31(3):364-369