Abstract

Objective: The aim of this study was to compare the treatment effects of high-intensity focused ultrasound (HIFU) and laparoscopic excision (LE) in patients with adenomyosis and infertility.

Materials and methods: A total of 93 patients with adenomyosis and infertility who were treated with HIFU (50 patients) or LE (43 patients) from January 2012 to January 2017 at the Third Xiangya Hospital of Central South University were retrospectively analyzed. Clinical characteristics including dysmenorrhea severity pain score, menorrhagia severity scores, reproductive outcomes, complications during pregnancy and delivery, adverse effects, surgical complications, and other clinical variables were compared between the HIFU and LE groups.

Results: Of the total 93 patients with adenomyosis and infertility, 50 were treated with HIFU and 43 underwent LE. Both HIFU and LE treatments achieved significant relief of dysmenorrhea and menorrhagia. The total hospital stay was shorter in patients treated with HIFU than in those who underwent LE surgery. Neither HIFU nor LE treatment led to severe complications after treatment. Most importantly, patients treated with HIFU showed significantly higher pregnancy rates and natural conception rates than those who underwent LE surgery. Notably, in the HIFU treatment group, those with diffuse adenomyotic lesions had significantly lower postoperative pregnancy rates than those with focal adenomyosis.

Conclusion: HIFU showed a safe and effective profile as a therapeutic management option for patients with adenomyosis. In comparison with LE, HIFU treatment achieved better postoperative reproductive outcomes. HIFU treatment should be encouraged and implemented in clinical practice.

摘要

目的：本研究的目的是比较高强度聚焦超声（HIFU）和腹腔镜切除术（LE）在子宫腺肌病和不育症患者中的治疗效果。

材料与方法：回顾性分析2012年1月至2017年1月在中南大学湘雅三医院接受HIFU（50例）或LE（43例）治疗的子宫腺肌症和不孕症患者93例。比较HIFU组和LE组的临床特征，包括痛经严重程度疼痛评分，月经过多严重程度评分，生殖结局，妊娠和分娩期间的并发症，不良反应，手术并发症以及其他临床变量。

结果：在总共93例子宫腺肌病和不育症患者中，有50例接受了HIFU治疗，其中43例接受了LE治疗。HIFU和LE治疗均可显着缓解痛经和月经过多。HIFU治疗的患者的总住院时间短于接受LE手术的患者。HIFU和LE治疗均未导致治疗后严重并发症。最重要的是，接受HIFU治疗的患者比接受LE手术的患者显示出更高的妊娠率和自然受孕率。值得注意的是，在HIFU治疗组中，弥漫性子宫腺肌病病变的患者术后妊娠率明显低于局灶性子宫腺肌病患者。

结论： HIFU作为子宫腺肌病患者的一种安全有效的治疗选择。与LE相比，HIFU治疗具有更好的术后生殖效果。应鼓励HIFU治疗并在临床实践中实施。