Abstract 【Objective】To explore the clinical efficacy of high intensity focused ultrasound (HIFU) combined with Ganodotropin releasing hormone agonist (GnRH-a)and levonorgestrel releasing intrauterine system(LNG-IUS) in the treatment of uterine adenomyoma. 【Methods】In this study,201 patients with adenomyoma of uterus who were hospitalized in Taihe Hospital of Shiyan city from October 2019 to November 2021 were selected and divided into three groups:HIFU alone group (Group A,n=62),HIFU combined with LNG-IUS group (Group B,n=68) and HIFU combined with GnRH-a and LNG-IUS group (Group C,n=71).The ablation rates of lesions on MRI before treatment and on the first day after treatment were compared in the three groups. Levels of uterine volume,hemoglobin,visual analogue scale (VAS) and CA125 were compared before treatment and 1,3,6,12 months after treatment. 【Results】There were no significant differences in the ablation rates among the three groups (P>0.05). After 1,3,6 and 12 months of treatment,the uterine volume,dysmenorrhea VAS score,and CA125 level in all three groups were lower than those before treatment,while the hemoglobin value was higher than that before treatment. After 6 and 12 months of treatment,the uterine volume,dysmenorrhea VAS score and CA125 level in Group C were significantly lower than those in Group A and B (P<0.05),but there was no significant difference between Group A and group B (P>0.05). The hemoglobin value of Group C was higher than that of Group A and group B after treatment (P<0.05),however,there was no significant difference between Group A and group B (P >0.05). 【Conclusion】HIFU alone,HIFU combined with LNG-IUS and HIFU combined with GnRH-a and LNG-IUS are all safe and effective in the treatment of uterine adenomyoma. However,the therapeutic effect of HIFU combined with both GnRH-a and LNG-IUS is much better than that of HIFU alone and HIFU combined with LNG-IUS,while its recurrence rate was lower than that of HIFU alone and HIFU combined with LNG-IUS.
LI Xiao-xiao,ZHANG Yi-qun,CHEN Jin-yun, et al. Efficacy of High Intensity Focused Ultrasound Combined with GnRH-a and LNG-IUS in the Treatment of Adenomyoma[J]. JOURNAL OF CLINICAL RESEARCH, 2023, 40(2): 168-172.
[1] 中国医师协会妇产科医师分会子宫内膜异位症专业委员会.子宫腺肌病诊治中国专家共识[J].中华妇产科杂志,2020,55(6):376-383.
[2] RASMUSSEN C K,HANSEN E S,DUEHOLM M. Two- and three-dimensional ultrasonographic features related to histopathology of the uterine endometrial-myometrial junctional zone[J].Acta Obstet Gynecol Scand,2019,98(2):205-214.
[3] 冷金花. 子宫腺肌病诊治中存在的问题[J].中国实用妇科与产科杂志,2019,35(5):489-492.
[4] 王智彪,郎景和.高强度聚焦超声消融与子宫腺肌病[J].中华妇产科杂志,2016,51(9):201-204.
[5] YANG X H,ZHANG X F,LIN B,et al. Combined therapeutic effects of HIFU,GnRH-a and LNG-IUS for the treatment of severe adenomyosis[J].Int J Hyperthermia,2019,36(1):486-492.
[6] 魏华莉,牛秀敏,王红霞.注射用醋酸亮丙瑞林微球联合左炔诺孕酮宫内释放系统治疗子宫腺肌病患者的临床疗效[J].医学临床研究,2019,36(9):1736-1738.
[7] GARCÍA-SOLARES J,DONNEZ J,DONNEZ O,et al. Pathogenesis of uterine adenomyosis:invagination or metaplasia[J].Fertil Steril,2018,109(3):371-379.
[8] SHUI L,MAO S H,WU Q R,et al. High-intensity focused ultrasound (HIFU) for adenomyosis:Two-year follow-up results[J].Ultrason Sonochem,2015,27:677-681.
[9] 郭银树,段华. 微创技术保守性治疗子宫腺肌病的现状与进展[J].中国微创外科杂志,2016,16(2):181-184.
[10] 张炼,王智彪,郎景和. 聚焦超声消融手术的临床应用现状及展望[J].中华医学杂志,2020,100 (13):965-967.
[11] RABINOVICI J,INBAR Y,EYLON S C,et al. Pregnancy and live birth after focused ultrasound surgery for symptomatic focal adenomyosis:a case report[J].Hum Reprod,2006,21(5):1255-1259.
[12] 张冬雅,郭红军,邱海峰. GnRH-α联合曼月乐治疗子宫腺肌症患者的疗效及对血清复发相关指标的影响[J].实用医学杂志,2019,35(1):84-87.
[13] SUN H Y,WANG L,HUANG S H,et al. High-intensity focused ultra-sound (HIFU) combined with gonadotropin-releasing hormoneanalogs (GnRHa) and levonorgestrel-releasing intrauterine system(LNG-IUS) for adenomyosis:a case series with long-term follow up[J].Int J Hyperthermia,2019,36(1):1179-1185.
[14] 郎景和,冷金花,邓姗,等. 左炔诺孕酮宫内缓释系统临床应用的中国专家共识[J].中华妇产科杂志,2019,54(12):815-825.
[15] 叶明珠,薛敏. 高强度聚焦超声在子宫腺肌病治疗中的应用[J].中国实用妇科与产科杂志,2019,35(5):522-527.
[16] ZHANG P H,SONG K,LI L,et al. Efficacy of combined levonorgestrel-releasing intrauterine system with gonadotropin-releasing hormone analog for the treatment of adenomyosis[J].Med Princ Pract,2013,22(5):480-483.
[17] 叶明珠,邓新粮,朱小刚,等.高强度聚焦超声消融技术联合GnRH-a及LNG-IUS治疗子宫腺肌病痛经的临床研究[J].中华妇产科杂志,2016,51(9):643-649.
[18] 孙永侠,姜雪勤. 促性腺激素释放激素激动剂在子宫肌腺病择期手术患者术前用药中的应用效果[J].医学临床研究,2019,36(1):134-136.
2023, Vol. 40 
