高强度聚焦超声治疗子宫肌瘤与腹腔镜下子宫肌瘤剔除术的比较
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摘要
目的对比高强度聚焦超声(HIFU)治疗子宫肌瘤与腹腔镜下子宫肌瘤剔除术(LM)的临床疗效。方法将我院妇科诊断收治的子宫肌瘤患者64例随机分为观察组和对照组,各32例。观察组应用HIFU对肌瘤进行消融治疗,对照组应用腹腔镜进行肌瘤剔除术治疗。比较两组患者手术时间、住院时间、术中出血量、术后恢复正常生活时间、治疗费用以及术后并发症发生情况;比较两组术后6个月症状改善情况,术后12个月肌瘤复发情况。结果观察组手术治疗时间(62.48±13.27)min低于对照组的(86.92±15.54)min;住院时间(3.56±0.73)d低于对照组的(6.15±0.87)d;观察组术中无出血,低于对照组出血量(102.76±12.15)ml;术后恢复正常生活时间观察组(4.15±0.76)d,低于对照组的(9.85±1.38)d,差异均有统计学意义(P<0.05);观察组治疗费用高于对照组,差异有统计学意义(P<0.05);观察组并发症发生4例(12.50%),对照组并发症发生5例(15.62%),差异无统计学意义(P>0.05);两组6个月症状改善情况与12个月复发情况比较,差异无统计学意义(P>0.05)。结论 HIFU消融治疗子宫肌瘤与LM治疗相比,具有安全、无创、治疗时间短、术中出血量少、术后恢复正常生活时间快等优点,临床治愈效果无明显差异,但治疗花费相对较高,临床可根据患者实际情况选择最佳治疗方案。
Objective To compare the clinical efficacy of high intensity focused ultrasound(HIFU) in the treatment of uterine fibroids and laparoscopic myomectomy(LM). Methods 64 patients with uterine fibroids admitted to our hospital were randomly divided into observation group and control group, 32 cases each. The observation group was treated with HIFU for ablation of the fibroids, and the control group was treated with laparoscopy for fibroids removal. The operation time, hospitalization time, intraoperative blood loss, postoperative normal life time, treatment cost and postoperative complications were compared between the two groups. The improvement of symptoms was compared between the two groups at 6 months postoperatively, and the recurrence of fibroids was observed 12 months after surgery.Results The operation time of the observation group(62.48 ±13.27) min was lower than that of the control group(86.92±15.54) min; the hospitalization time(3.56±0.73) d was lower than that of the control group(6.15±0.87) d; the observation group had no bleeding during operation. The amount of bleeding was lower than that of the control group(102.76 ±12.15) ml; the postoperative normal life time was observed in the observation group(4.15 ±0.76) d, which was lower than that in the control group(9.85±1.38) d, the difference was statistically significant(P<0.05). The observation group cost was higher than the control group, the difference was statistically significant(P<0.05); the observation group had 4 cases(12.50%) of complications, and the control group had 5 cases(15.62%), the difference was not statistically significant(P>0.05); the 6-month symptom improvement in the two groups was compared with the 12-month recurrence,the difference was not statistically significant(P>0.05).Conclusion Compared with LM treatment, HIFU ablation treatment has the advantages of safe,non-invasive, short treatment time, less intraoperative blood loss, and quicker normal life after surgery. There is no significant difference in clinical cure effect, but the treatment cost is relatively high. Clinically, the best treatment plan can be selected according to the actual situation of the patient.
Objective To compare the clinical efficacy of high intensity focused ultrasound(HIFU) in the treatment of uterine fibroids and laparoscopic myomectomy(LM). Methods 64 patients with uterine fibroids admitted to our hospital were randomly divided into observation group and control group, 32 cases each. The observation group was treated with HIFU for ablation of the fibroids, and the control group was treated with laparoscopy for fibroids removal. The operation time, hospitalization time, intraoperative blood loss, postoperative normal life time, treatment cost and postoperative complications were compared between the two groups. The improvement of symptoms was compared between the two groups at 6 months postoperatively, and the recurrence of fibroids was observed 12 months after surgery.Results The operation time of the observation group(62.48 ±13.27) min was lower than that of the control group(86.92±15.54) min; the hospitalization time(3.56±0.73) d was lower than that of the control group(6.15±0.87) d; the observation group had no bleeding during operation. The amount of bleeding was lower than that of the control group(102.76 ±12.15) ml; the postoperative normal life time was observed in the observation group(4.15 ±0.76) d, which was lower than that in the control group(9.85±1.38) d, the difference was statistically significant(P<0.05). The observation group cost was higher than the control group, the difference was statistically significant(P<0.05); the observation group had 4 cases(12.50%) of complications, and the control group had 5 cases(15.62%), the difference was not statistically significant(P>0.05); the 6-month symptom improvement in the two groups was compared with the 12-month recurrence,the difference was not statistically significant(P>0.05).Conclusion Compared with LM treatment, HIFU ablation treatment has the advantages of safe,non-invasive, short treatment time, less intraoperative blood loss, and quicker normal life after surgery. There is no significant difference in clinical cure effect, but the treatment cost is relatively high. Clinically, the best treatment plan can be selected according to the actual situation of the patient.
引文
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[7]金琳,王迎春,封岚,等.超微血流成像技术评估高强度聚焦超声治疗子宫肌瘤疗效的应用价值[J].中华超声影像学杂志,2018,27(4):334-337.
[8]郑献红.腹腔镜下子宫肌瘤剔除术与高强度聚焦超声治疗子宫肌瘤的临床疗效比较[J].实用癌症杂志,2017,32(7):1186-1188.
[9]Shiota M,Kotani Y,Umemoto M,et al.Estimation of preoperative uterine weight in uterine myoma and uterine adenomyosis[J].Asian J Endosc Surg,2012,5(3):123-125.
[10]曾飚,周敏,华媛媛,等.高强度聚焦超声治疗子宫肌瘤的安全性分析[J].重庆医学,2013,42(4):370-372.
[11]周艳芝,杨兰,张珊瑚,等.高能聚焦超声治疗子宫肌瘤疗效的Meta分析[J].中国循证医学杂志,2013,13(10):1219-1223.
[12]张英,华克勤.子宫肌瘤的处理与妊娠相关性[J].中国实用妇科与产科杂志,2016,32(2):135-139.
[13]蒋冬,熊正爱,周昆,等.子宫肌瘤三种手术方式的效果分析[J].激光杂志,2013,34(4):125-126.
[14]华媛媛,周敏,胡建国,等.高强度聚焦超声治疗子宫肌瘤的有效性和影像学特征分析[J].解放军医学杂志,2014,39(3):212-216.
[2]马亚慧.高强度聚焦超声消融治疗子宫肌瘤的疗效与安全性评价[J].现代诊断与治疗,2018,29(13):2091-2092.
[3]沈阳,许茜,徐洁,等.子宫肌瘤危险因素的流行病学调查研究[J],实用妇产科杂志,2013,29(3):189-193.
[4]王文娟.妇产科子宫肌瘤患者腹腔镜子宫肌瘤剔除术临床效果探讨[J].当代医学,2017,23(4):96-97.
[5]彭宇洁,侯玉兰,潘晓如.不同手术方式对子宫肌瘤患者卵巢功能和性功能的影响探讨[J].医学综述,2014,20(15):2871-2872.
[6]姜曼,赵卫,姚瑞红,等.高强度聚焦超声消融治疗子宫肌瘤的临床应用[J].介入放射学杂志,2013,22(1):82-85。
[7]金琳,王迎春,封岚,等.超微血流成像技术评估高强度聚焦超声治疗子宫肌瘤疗效的应用价值[J].中华超声影像学杂志,2018,27(4):334-337.
[8]郑献红.腹腔镜下子宫肌瘤剔除术与高强度聚焦超声治疗子宫肌瘤的临床疗效比较[J].实用癌症杂志,2017,32(7):1186-1188.
[9]Shiota M,Kotani Y,Umemoto M,et al.Estimation of preoperative uterine weight in uterine myoma and uterine adenomyosis[J].Asian J Endosc Surg,2012,5(3):123-125.
[10]曾飚,周敏,华媛媛,等.高强度聚焦超声治疗子宫肌瘤的安全性分析[J].重庆医学,2013,42(4):370-372.
[11]周艳芝,杨兰,张珊瑚,等.高能聚焦超声治疗子宫肌瘤疗效的Meta分析[J].中国循证医学杂志,2013,13(10):1219-1223.
[12]张英,华克勤.子宫肌瘤的处理与妊娠相关性[J].中国实用妇科与产科杂志,2016,32(2):135-139.
[13]蒋冬,熊正爱,周昆,等.子宫肌瘤三种手术方式的效果分析[J].激光杂志,2013,34(4):125-126.
[14]华媛媛,周敏,胡建国,等.高强度聚焦超声治疗子宫肌瘤的有效性和影像学特征分析[J].解放军医学杂志,2014,39(3):212-216.