Fan Ling-Xiu, Zhang Ying, Yang Lei-Lei, Ji Xiao-Li, Wang Yan, Huang Ye-Fang, Shi Ling, Wen Yi
Department of Gynecology, Affiliated Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, 610072, Sichuan, China.
Arch Gynecol Obstet. 2024 May;309(5):1765-1773. doi: 10.1007/s00404-023-07340-x. Epub 2024 Feb 12.
To analyze the efficacy of high-intensity focused ultrasound (HIFU) for adenomyosis and postoperative recurrence and its influencing factors.
Clinical and follow-up data of 308 patients with adenomyosis who were treated with HIFU in Haifu Center, Affiliated Hospital of Chengdu University of Traditional Chinese Medicine from September 2017 to January 2022 were retrospectively analyzed. The recurrence of adenomyosis and the efficacy of HIFU at 6 months after surgery were followed up. To explore factors influencing postoperative prognosis and recurrence, the following variables were analyzed: patients' age, course of disease, gravidity and parity, size of the uterus, duration of HIFU, duration of irradiation, treatment intensity, dysmenorrhea score, time of follow-up, combined treatment of traditional Chinese medicine (TCM), western medicine adjuvant treatment, lesion location and type, and menorrhagia.
Among the 308 patients, 238 (77%) were followed up from 6 to 36 months, with an average follow-up time of 15.24 ± 9.97 months. The other 70 (23%) were lost to follow-up. At 6-month after surgery, efficacy rates of dysmenorrhea and menorrhagia management were 86.7% and 89.3%, respectively. Postoperative recurrence rates were 4.8% (1-12 months), 9.0% (12-24 months), and 17.0% (24-36 months) for dysmenorrhea; and 6.3% (1-12 months), 2.4% (12-24 months), and 12.2% (24-36 months) for menorrhagia. Multivariate logistic regression analyses showed that parity (P = 0.043, OR = 1.773, 95% CI 1.018-3.087), uterine size (P = 0.019, OR = 1.004, 95% CI 1.001-1.007), combined treatment of TCM (P = 0.047, OR = 1.846, 95% CI 1.008-3.381), diffuse lesion type (P = 0.013, OR = 0.464, 95% CI 0.254-0.848) and ablation rate (P = 0.015, OR = 0.481, 95%CI 0.267-0.868) were prognostic factors (P < 0.05). Age, course of disease, gravidity, duration of HIFU, duration of irradiation, treatment intensity, preoperative dysmenorrhea score, time of follow-up, western medicine adjuvant therapy, lesion location, and preoperative menstrual volume had no effect on prognosis (P > 0.05).
HIFU can effectively relieve dysmenorrhea and reduce menstrual volume in patients with adenomyosis. Parity, uterine size, lesion type (diffuse), and ablation rate are risk factors for symptom recurrence after HIFU, while the combination of TCM therapy is a protective factor for relapse. We, therefore, recommend TCM in the adjuvant setting after HIFU according to patient condition.
分析高强度聚焦超声（HIFU）治疗子宫腺肌病的疗效、术后复发情况及其影响因素。
回顾性分析2017年9月至2022年1月在成都中医药大学附属医院海扶中心接受HIFU治疗的308例子宫腺肌病患者的临床及随访资料。随访子宫腺肌病的复发情况及术后6个月时HIFU的疗效。为探讨影响术后预后及复发的因素，分析以下变量：患者年龄、病程、孕产次、子宫大小、HIFU持续时间、照射时间、治疗强度、痛经评分、随访时间、中西医结合治疗、西药辅助治疗、病灶位置及类型、月经过多情况。
308例患者中，238例（77%）获得6至36个月的随访，平均随访时间为15.24±9.97个月。另外70例（23%）失访。术后6个月时，痛经及月经过多的治疗有效率分别为86.7%和89.3%。痛经的术后复发率在1至12个月为4.8%，12至24个月为9.0%，24至36个月为17.0%；月经过多的术后复发率在1至12个月为6.3%，12至24个月为2.4%，24至36个月为12.2%。多因素logistic回归分析显示，孕产次（P = 0.043，OR = 1.773，95%CI 1.018 - 3.087）、子宫大小（P = 0.019，OR = 1.004，95%CI 1.001 - 1.007）、中西医结合治疗（P = 0.047，OR = 1.846，95%CI 1.008 - 3.381）、弥漫性病灶类型（P = 0.013，OR = 0.464，95%CI 0.254 - 0.848）及消融率（P = 0.015，OR = 0.481，95%CI 0.267 - 0.868）是预后因素（P < 0.05）。年龄、病程、妊娠次数、HIFU持续时间、照射时间、治疗强度、术前痛经评分、随访时间、西药辅助治疗、病灶位置及术前月经量对预后无影响（P > 0.05）。
HIFU能有效缓解子宫腺肌病患者的痛经并减少月经量。孕产次、子宫大小、病灶类型（弥漫性）及消融率是HIFU术后症状复发的危险因素，而中西医结合治疗是复发的保护因素。因此，我们建议根据患者情况在HIFU术后辅助应用中药。
