【摘要】：研究背景： 子宮腺肌病是育齡期婦女常見的一種良性病變，臨床表現(xiàn)為進(jìn)行性加重的痛經(jīng)、月經(jīng)過(guò)多、不孕等。因其病灶邊界不清又無(wú)包膜，致使保守性手術(shù)治療的復(fù)發(fā)率較高，一直是臨床醫(yī)生面臨的難題。 高強(qiáng)度聚焦超聲(HIFU)利用超聲波的穿透性和可聚焦性，使靶區(qū)組織發(fā)生凝固性壞死，從而達(dá)到治療腫瘤的目的。HIFU作為一種無(wú)創(chuàng)治療的方法，能顯著改善腺肌病患者痛經(jīng)、月經(jīng)過(guò)多等臨床癥狀，而對(duì)卵巢內(nèi)分泌功能影響甚小。丙酸睪丸酮是一種雄激素類藥物，可以降低或抑制雌激素水平,使異位內(nèi)膜萎縮,子宮血管收縮。HIFU治療前短時(shí)間使用可減少子宮血供，縮小子宮體積，這為改變組織聲環(huán)境，提高治療效率提供了可能。本課題將探討丙酸睪丸酮在HIFU治療子宮腺肌病中的作用及其安全性問題。 目的： 評(píng)估丙酸睪丸酮在HIFU治療子宮腺肌病中的應(yīng)用價(jià)值。 資料和方法： 回顧性分析重慶涪陵中心醫(yī)院經(jīng)HIFU治療的62例子宮腺肌病患者。比較使用丙酸睪丸酮組及對(duì)照組在治療時(shí)間、輻照時(shí)間、能效因子（EEF）、消融率、出現(xiàn)團(tuán)塊狀灰度變化情況。并評(píng)價(jià)HIFU治療子宮腺肌病的安全性問題。 結(jié)果： 丙酸睪丸酮組與對(duì)照組比較，兩組在治療中的治療時(shí)間、輻照時(shí)間、EEF和消融率上無(wú)顯著差異。在丙酸睪丸酮組的患者中，病灶出現(xiàn)團(tuán)塊狀灰度變化的比例為80%（32/40）；而對(duì)照組中出現(xiàn)團(tuán)塊狀灰度變化的比例為50%（11/22）。結(jié)果顯示丙酸睪丸酮組的病灶出現(xiàn)團(tuán)塊狀灰度變化的概率大于對(duì)照組，，有顯著差異（χ2=6.010，P=0.014）；但兩組比較，出現(xiàn)團(tuán)塊狀灰度變化的時(shí)間無(wú)顯著差異（t=0.613，P=0.542）。兩組患者未出現(xiàn)嚴(yán)重的副反應(yīng)。 結(jié)論： 1.丙酸睪丸酮不能有效地增強(qiáng)HIFU治療子宮腺肌病的效率，但對(duì)提高團(tuán)塊狀灰度出現(xiàn)的概率有意義，有利于HIFU治療的監(jiān)控。 2.鎮(zhèn)靜鎮(zhèn)痛下HIFU治療子宮腺肌病是安全有效的。
[Abstract]:Background: adenomyosis is a common benign disease in women of childbearing age. Its clinical manifestations are progressive aggravation of dysmenorrhea, menorrhagia, infertility and so on. The recurrence rate of conservative surgical treatment is high because of its unclear boundary and no capsule, which has always been a difficult problem for clinicians. High intensity focused ultrasound (HIFU) makes use of the penetrating and focusing properties of ultrasound to cause coagulation necrosis of the target tissue, thus achieving the purpose of treating tumor. As a noninvasive treatment method, HIFU can significantly improve dysmenorrhea in patients with adenomyosis. Menstruation and other clinical symptoms, but the ovarian endocrine function has little impact. Testosterone propionate is a androgen drug that reduces or suppresses estrogen levels, causes ectopic endometrial atrophy and uterine vasoconstriction. Improved treatment efficiency provides the possibility. The purpose of this study was to investigate the role and safety of testosterone propionate in the treatment of adenomyosis with HIFU. Objective: to evaluate the value of testosterone propionate in the treatment of adenomyosis with HIFU. Materials and methods: 62 cases of adenomyosis treated by HIFU in Fuling Central Hospital of Chongqing were retrospectively analyzed. The treatment time, irradiation time and (EEF), ablation rate of energy efficiency factor were compared between the testosterone propionate group and the control group. To evaluate the safety of HIFU in the treatment of adenomyosis. Results: there was no significant difference in treatment time, irradiation time, EEF and ablation rate between testosterone propionate group and control group. In the testosterone propionate group, 80% (32 / 40) of the lesions had mass gray changes, while 50% (11 / 22) in the control group. The results showed that the probability of mass gray scale change in testosterone propionate group was significantly higher than that in control group (蠂 ~ 2 = 6.010 ~ P ~ (0.014). However, there was no significant difference between the two groups in the time of mass gray change (t0. 613, P < 0. 542). There were no serious side effects in both groups. Conclusion: 1. Testosterone propionate can not effectively enhance the efficiency of HIFU in the treatment of adenomyosis, but it is significant to increase the probability of mass gray level, which is beneficial to the monitoring of HIFU therapy. 2. HIFU is safe and effective in the treatment of adenomyosis under sedation and analgesia.
【學(xué)位授予單位】：重慶醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2014
【分類號(hào)】：R711.71

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