| 金 男,杨洪艳,裴 会,姜姗姗,李 烁.有生育要求的子宫肌瘤患者经高强度聚焦超声消融治疗前后子宫内膜容受性、性激素的变化及其妊娠结局的影响因素分析[J].,2022,(18):3454-3458 |
| 有生育要求的子宫肌瘤患者经高强度聚焦超声消融治疗前后子宫内膜容受性、性激素的变化及其妊娠结局的影响因素分析 |
| Changes of Endometrial Receptivity, Sex Hormones and Influencing Factors of Pregnancy Outcome in Patients with Hysteromyoma with Fertility Requirements before and after High Intensity Focused Ultrasound Ablation |
| 投稿时间：2022-04-06 修订日期：2022-04-28 |
| DOI：10.13241/j.cnki.pmb.2022.18.009 |
| 中文关键词: 子宫肌瘤 高强度聚焦超声消融 子宫内膜容受性 性激素 妊娠结局 影响因素 |
| 英文关键词: Hysteromyoma High intensity focused ultrasound ablation Endometrial receptivity Sex hormones Pregnancy outcome Influence factor |
| 基金项目:辽宁省科学技术计划资助项目（2018223132） |
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| 中文摘要: |
| 摘要 目的：观察有生育要求的子宫肌瘤患者经高强度聚焦超声（HIFU）消融治疗前后子宫内膜容受性、性激素的变化，并分析其妊娠结局的影响因素。方法：选择2018年11月~2020年6月期间在我院接受HIFU消融术治疗且有生育要求，符合条件的子宫肌瘤患者176例，均接受HIFU消融治疗，观察治疗前后子宫内膜容受性、性激素的变化和并发症发生情况。根据治疗后是否妊娠将其分为妊娠组和未妊娠组，经单因素与多因素Logistic回归分析妊娠结局的影响因素。结果：术后3个月，子宫肌瘤患者的子宫内膜厚度较术前增厚，子宫内膜容积较术前增加，血管化指数（VI）、血流指数（FI）较术前升高（P<0.05）。与术前相比，术后3个月的雌二醇（E2）、促卵泡生长激素（FSH）、促黄体生长素（LH）无明显变化，组间对比无统计学差异（P>0.05）。HIFU治疗的患者中，并发症发生率为2.84%。176例患者中，妊娠患者118例纳为妊娠组，剩余58例未妊娠纳为未妊娠组，妊娠率为67.05%。单因素比较发现：妊娠结局与年龄、术前不孕史、术后症状改善、肌瘤分型、术后靶肌瘤体积缩小率≥50%、体质量指数有关（P<0.05）。多因素Logistic回归分析结果显示年龄、术前不孕史、肌瘤分型是妊娠结局的影响因素（P<0.05）。结论：有生育要求的子宫肌瘤患者经HIFU消融治疗后，子宫内膜容受性得到明显改善，且对患者的性激素分泌无明显影响，安全可靠。此外，年龄、术前不孕史、肌瘤分型是妊娠结局的影响因素。 |
| 英文摘要: |
| ABSTRACT Objective: To observe the changes of endometrial receptivity and sex hormones in patients with hysteromyoma who have fertility requirements before and after ablation with high intensity focused ultrasound (HIFU), and to analyze the influencing factors of pregnancy outcome. Methods: 176 eligible patients with hysteromyoma who received HIFU ablation in our hospital from November 2018 to June 2020 were selected. They all received HIFU ablation. The changes of endometrial receptivity, sex hormones and complications before and after treatment were observed. They were divided into pregnancy group and non pregnancy group according to whether they were pregnant after treatment. The influencing factors of pregnancy outcome were analyzed by univariate and multivariate logistic regression. Results: 3 months after operation, the endometrial thickness, endometrial volume, vascularization index (VI) and blood flow index (FI) of patients with hysteromyoma were thicker than those before operation (P<0.05). There were no significant changes in estradiol (E2), follicle growth hormone (FSH) and luteinizing hormone (LH) 3 months after operation, and there was no significant difference between the groups (P>0.05). Among the patients treated with HIFU, the incidence of complications was 2.84%. Among the 176 patients, 118 pregnant patients were included in the pregnancy group, and the remaining 58 non pregnant patients were included in the non pregnancy group. The pregnancy rate was 67.05%. Univariate comparison showed that the pregnancy outcome was related to age, preoperative infertility history, postoperative symptom improvement, myoma classification, postoperative target myoma volume reduction rate ≥ 50% and body mass index(P<0.05). Multivariate logistic regression analysis showed that age, preoperative infertility history and myoma classification were the influencing factors of pregnancy outcome(P<0.05). Conclusion: After HIFU ablation, the endometrial receptivity of patients with hysteromyoma with fertility requirements is significantly improved, and has no significant effect on the secretion of sex hormones. It is safe and reliable. In addition, age, preoperative infertility history and myoma classification are the influencing factors of pregnancy outcome. |
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