运动处方对HIFU术后子宫腺肌病患者痛经的影响
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摘要
目的:评估运动处方联合高强度聚焦超声(high intensity focused ultrasound,HIFU)对子宫腺肌病患者痛经的影响。方法:纳入2017年1月到2018年3月HIFU治疗的子宫腺肌病患者,据患者术后对运动处方医嘱(150 min/周有氧运动)的执行情况分组,随访术后3、6、12个月痛经视觉模拟评分法(visual analogue score,VAS)评分及子宫体积变化。结果:本研究纳入217例子宫腺肌病女性患者,115例患者执行运动处方列为"运动组",运动处方依从率53.0%,102例患者无运动列为"无运动组",2组患者基线资料及HIFU治疗方案差异无统计学意义,组间具有可比性(P>0.05)。运动组和无运动组术前VAS评分差异无统计学意义(P=0.092),术后3、6、12个月运动组VAS评分分别为3.0(2.0,4.0)、2.0(0.0,3.0)和2.5(1.0,4.0)分,均低于无运动组的3.5(3.0,5.0)、4.0(2.0,5.8)和4.5(2.0,6.0)分,差异有统计学意义(P<0.01);术后3、6个月运动组子宫体积缩小中位数为9.780、14.046 cm3,而无运动组为2.935、-2.432 cm3,运动组术后3、6个月子宫体积缩小程度均高于无运动组(P<0.01)。结论:HIFU术后结合运动处方能够更有效降低VAS评分,缓解痛经症状,缩小子宫体积;运动处方可以作为子宫腺肌病HIFU术后康复治疗的方案,改善患者自我评价。
Objective:To investigate the effect of exercise prescription combined with high-intensity focused ultrasound(HIFU)on dysmenorrhea in patients with adenomyosis. Methods:The patients with adenomyosis who underwent HIFU from January 2017 to March 2018 were enrolled. According to the implementation of exercise prescription(aerobic exercise 150 minutes per week)after surgery,the patients were divided into exercise group and non-exercise group. The patients were followed up at 3,6,and 12 months after surgery to observe visual analogue scale(VAS)score of dysmenorrhea and the change in uterine volume. Results:A total of 217 patients were enrolled,with 115 in the exercise group(the rate of compliance with exercise prescription was 53.0%)and 102 in the non-exercise group. There were no significant differences in baseline data and HIFU regimen between the two groups(P>0.05). Before surgery,there was no significant difference in VAS score between the two groups(P=0.092),and at 3,6,and 12 months after surgery,the exercise group had a significantly lower VAS score than the non-exercise group[3.0(2.0,4.0)/2.0(0.0,3.0)/2.5(1.0,4.0)vs. 3.5(3.0,5.0)/4.0(2.0,5.8)/4.5(2.0,6.0),all P<0.01]. At 3 and 6 months after surgery,the medians of the reduction in uterine volume were 9.780 cm3 and 14.046 cm3 in the exercise group and 2.935 cm3 and-2.432 cm3 in the non-exercise group,and the exercise group had a significantly greater reduction in uterine volume than the non-exercise group(P<0.01). Conclusion:Exercise prescription after HIFU can effectively reduce VAS score,alleviate the symptom of dysmenorrhea,and reduce uterine volume. Therefore,exercise prescription can be used as a rehabilitation treatment regimen for adenomyosis after HIFU and can improve patients' self-evaluation.
Objective:To investigate the effect of exercise prescription combined with high-intensity focused ultrasound(HIFU)on dysmenorrhea in patients with adenomyosis. Methods:The patients with adenomyosis who underwent HIFU from January 2017 to March 2018 were enrolled. According to the implementation of exercise prescription(aerobic exercise 150 minutes per week)after surgery,the patients were divided into exercise group and non-exercise group. The patients were followed up at 3,6,and 12 months after surgery to observe visual analogue scale(VAS)score of dysmenorrhea and the change in uterine volume. Results:A total of 217 patients were enrolled,with 115 in the exercise group(the rate of compliance with exercise prescription was 53.0%)and 102 in the non-exercise group. There were no significant differences in baseline data and HIFU regimen between the two groups(P>0.05). Before surgery,there was no significant difference in VAS score between the two groups(P=0.092),and at 3,6,and 12 months after surgery,the exercise group had a significantly lower VAS score than the non-exercise group[3.0(2.0,4.0)/2.0(0.0,3.0)/2.5(1.0,4.0)vs. 3.5(3.0,5.0)/4.0(2.0,5.8)/4.5(2.0,6.0),all P<0.01]. At 3 and 6 months after surgery,the medians of the reduction in uterine volume were 9.780 cm3 and 14.046 cm3 in the exercise group and 2.935 cm3 and-2.432 cm3 in the non-exercise group,and the exercise group had a significantly greater reduction in uterine volume than the non-exercise group(P<0.01). Conclusion:Exercise prescription after HIFU can effectively reduce VAS score,alleviate the symptom of dysmenorrhea,and reduce uterine volume. Therefore,exercise prescription can be used as a rehabilitation treatment regimen for adenomyosis after HIFU and can improve patients' self-evaluation.
引文
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[19] Chen J,Li Y,Wang Z,et al. Evaluation of high-intensity focused ultrasound ablation for uterine fibroids:an IDEAL prospective exploration study[J]. BJOG,2018,125(3):354-364.
[20] Huskisson EC. Measurement of pain[J]. Lancet,1974,2(7889):1127-1131.
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[23] World Health Organization. Global recommendations on physical activity for health[EB/OL].2010,Geneva.https://www.who.int/dietphysicalactivity/factsheet_recommendations/en/.
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[25] Yang Z,Cao YD,Hu LN,et al. Feasibility of laparoscopic highintensity focused ultrasound treatment for patients with uterine localized adenomyosis[J]. Fertil Steril,2009,91(6):2338-2343.
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[27] Koltyn KF,Brellenthin AG,Cook DB,et al. Mechanisms of exercise-induced hypoalgesia[J]. J Pain,2014,15(12):1294-1304.
[28] Taran FA,Weaver AL,Coddington CC,et al. Understanding adenomyosis:a case control study[J]. Fertil Steril,2010,94(4):1223-1228.
[29] Babyak M,Blumenthal JA,Herman S,et al. Exercise treatment for major depression:maintenance of therapeutic benefit at 10 months[J]. Psychosom Med,2000,62(5):633-638.
[30] Brown JC,Winters-Stone K,Lee A,et al. Cancer,physical activity,and exercise[J]. Compr Physiol,2012,2(4):2775-2809.
[31] Huang X,Yu D,Zou M,et al. The effect of exercise on high-intensity focused ultrasound treatment efficacy in uterine fibroids and adenomyosis:a retrospective study[J].BJOG,2017,124(S3):46-52.
[2] Vercellini P,ViganòP,Somigliana E,et al. Adenomyosis:epidemiological factors[J]. Best Pract Res Clin Obstet Gynaecol,2006,20(4):465-477.
[3] Bergeron C,Amant F,Ferenczy A. Pathology and physiopathology of adenomyosis[J]. Best Pract Res Clin Obstet Gynaecol,2006,20(4):511-521.
[4] Ferenczy A. Pathophysiology of adenomyosis[J]. Hum Reprod Update,1998,4(4):312-322.
[5] Wood C. Surgical and medical treatment of adenomyosis[J]. Hum Reprod Update,1998,4(4):323-336.
[6] Farquhar C,Brosens I. Medical and surgical management of adenomyosis[J]. Best Pract Res Clin Obstet Gynaecol,2006,20(4):603-616.
[7] Wu F,Wang ZB,Chen WZ,et al. Extracorporeal focused ultrasound surgery for treatment of human solid carcinomas:early Chinese clinical experience[J]. Ultrasound Med Biol,2004,30(2):245-260.
[8] Wang W,Wang Y. Safety and efficacy of high intensity focused ultrasound ablation therapy for adenomyosis[J]. Acad Radiol,2009,16(11):1416-1423.
[9] 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.
[10] Zhang X,Li K,Xie B,et al. Effective ablation therapy of adenomyosis with ultrasound-guided high-intensity focused ultrasound[J]. Int J Gynaecol Obstet,2014,124(3):207-211.
[11] Chen J,Chen W,Zhang L,et al. Safety of ultrasound-guided ultrasound ablation for uterine fibroids and adenomyosis:a review of 9988cases[J]. Ultrason Sonochem,2015,27():671-676.
[12] Vitonis AF,Hankinson SE,Hornstein MD,et al. Adult physical activity and endometriosis risk[J]. Epidemiology,2010,21(1):16-23.
[13] Bonocher CM,Montenegro ML,Rosa E Silva JC,et al. Endometriosis and physical exercises:a systematic review[J]. Reprod Biol Endocrinol,2014,12:4.
[14] Ricci E,ViganòP,Cipriani S,et al. Physical activity and endometriosis risk in women with infertility or pain:systematic review and meta-analysis[J]. Medicine(Baltimore),2016,95(40):e4957.
[15] Leyendecker G,Kunz G. Endometriosis and adenomyosis[J]. Zentralbl Gynakol,2005,127(5):288-294.
[16] Garber CE,Blissmer B,Deschenes MR,et al. American College of Sports Medicine position stand. Quantity and quality of exercise for developing and maintaining cardiorespiratory,musculoskeletal,and neuromotor fitness in apparently healthy adults:guidance for prescribing exercise[J]. Med Sci Sports Exerc,2011,43(7):1334-1359.
[17] Tamai K,Togashi K,Ito T,et al. MR imaging findings of adenomyosis:correlation with histopathologic features and diagnostic pitfalls[J]. Radiographics,2005,25(1):21-40.
[18] Orsini LF,Salardi S,Pilu G,et al. Pelvic organs in premenarcheal girls:real-time ultrasonography[J]. Radiology,1984,153(1):113-116.
[19] Chen J,Li Y,Wang Z,et al. Evaluation of high-intensity focused ultrasound ablation for uterine fibroids:an IDEAL prospective exploration study[J]. BJOG,2018,125(3):354-364.
[20] Huskisson EC. Measurement of pain[J]. Lancet,1974,2(7889):1127-1131.
[21] Shui L,Mao S,Wu Q,et al. High intensity focused ultrasound(HIFU)for adenomyosis:two-year follow up results[J]. Ultrason Sonochem,2015,27:677-681.
[22] Booth FW,Roberts CK,Laye MJ. Lack of exercise is a major cause of chronic diseases[J]. Compr Physiol,2012,2(2):1143-1211.
[23] World Health Organization. Global recommendations on physical activity for health[EB/OL].2010,Geneva.https://www.who.int/dietphysicalactivity/factsheet_recommendations/en/.
[24] Moore SC,Lee IM,Weiderpass E,et al. Association of leisuretime physical activity with risk of 26 types of cancer in 1.44 million adults[J]. JAMA Internal Medicine,2016,176(6):816-825.
[25] Yang Z,Cao YD,Hu LN,et al. Feasibility of laparoscopic highintensity focused ultrasound treatment for patients with uterine localized adenomyosis[J]. Fertil Steril,2009,91(6):2338-2343.
[26] Jones MD,Booth J,Taylor JL,et al. Aerobic training increases pain tolerance in healthy individuals[J]. Med Sci Sports Exerc,2014,46(8):1640-1647.
[27] Koltyn KF,Brellenthin AG,Cook DB,et al. Mechanisms of exercise-induced hypoalgesia[J]. J Pain,2014,15(12):1294-1304.
[28] Taran FA,Weaver AL,Coddington CC,et al. Understanding adenomyosis:a case control study[J]. Fertil Steril,2010,94(4):1223-1228.
[29] Babyak M,Blumenthal JA,Herman S,et al. Exercise treatment for major depression:maintenance of therapeutic benefit at 10 months[J]. Psychosom Med,2000,62(5):633-638.
[30] Brown JC,Winters-Stone K,Lee A,et al. Cancer,physical activity,and exercise[J]. Compr Physiol,2012,2(4):2775-2809.
[31] Huang X,Yu D,Zou M,et al. The effect of exercise on high-intensity focused ultrasound treatment efficacy in uterine fibroids and adenomyosis:a retrospective study[J].BJOG,2017,124(S3):46-52.