Study On The Clinical Efficacy Of High-Intensity Focused Ultrasound Combined With GnRH-a In The Treatment Of Adenomyoma

BackgroundUterine adenomyosis(AM)refers to endometrial glands and stroma with growth and secretion functions that invade the uterine muscle layer under the action of a variety of pathogenic factors.Progressive dysmenorrhea is a benign disease dependent on sex hormones.The disease occurs predominantly in women of childbearing age between 30 and 50 years of age,but the disease has tended to become younger in recent years.A small number of endometriums have limited growth into nodules or clumps in the myometrium,similar to uterine muscle wall fibroids,called adenomyoma.Because the etiology of the disease has not been determined,its treatment methods have not been completely unified.At present,the clinical treatment methods are mainly divided into surgical treatment and conservative treatment.With the continuous advancement of technology,with the increasing demand for women to retain the uterus and the second child policy,more and more women choose conservative treatment.Conservative treatment is mainly drug treatment,the most commonly used is gonadotropin releasing hormone agonist(Gonadotropin releasing hormone agonist(GnRH-a)).The clinical effect is significant,but the side effects of the drug are relatively large.In recent years,China's independent research and development of high intensity focused ultrasound(HIFU)is one of the effective treatment methods for adenomyoma.This study uses three methods to treat adenomyoma with large lesions,researches its clinical effect and analyzes with statistical methods,and provides new clinical methods for the diagnosis and treatment of adenomyoma.ObjectiveThe study comparatively analyzed the clinical efficacy of three high-intensity focused ultrasound(HIFU)therapy,gonadotropin-releasing hormone agonist(GnRH-a)therapy and high-intensity focused ultrasound therapy combined with GnRH-a in the treatment of adenomyoma.MethodsCollected 90 patients with adenomyoma diagnosed in The First Affiliated Hospital of Xinxiang Medical College from June 2016 to June 2018 and the diameter of the lesion was4-7cm.The patients were those who requested to keep the uterus,and their age was controlled between 30-50 years.The diagnosis was based on "Clinical Diagnosis and Treatment Guide-Obstetrics and Gynecology ",before treatment,the three patients will be explained in detail about the three treatment methods and possible risks during the treatment process.Patients chose a treatment method voluntarily according to their condition and willingness,and were divided into simple high-intensity focused ultrasound(HIFU)treatment(group A),pure gonadotropin-releasing hormone agonist(GnRH-a)treatment(group B),and high-intensity Focused ultrasound treatment combined with GnRH-a treatment(group C)30 cases each.The three groups of patients received the same nursing model and routine treatment during the hospital.Group A used the high-intensity focused ultrasound of JC-type focused ultrasound tumor treatment system produced by Chongqing Haifu Medical Technology Co.,Ltd.to treat adenomyoma;group B applied leuprolide for injection produced by Beijing Boente Pharmaceutical Co.,Ltd.Sustained-release microspheres,3.75 mg / branch,injected subcutaneously,and continued treatment for 3 courses(28 days as a course).Group C applied leuprorelin sustained-release microspheres for injection,manufactured by Beijing Boente Pharmaceutical Co.,Ltd.,with a specification of 3.75 mg / branch.After 3 courses of treatment(28 days as a course),the high intensity of group A was used.Focused ultrasound in the treatment of adenomyoma of the uterus.By comparing and analyzing the lesion size,dysmenorrhea,menstrual volume score and CA125 value of patients before treatment,3months,6 months,and 12 months after treatment,the therapeutic effects of the three treatment methods were evaluated.The obtained data were analyzed by SPSS 21.0statistical software.Results1)Comparison of lesion volume before and after treatment in the three groups: March,June,and December after treatment were reduced compared with those before treatment.The lesion volume in group C was significantly smaller than that in groups A and B,and the differences were statistically significant.(P <0.05).2)Comparison of dysmenorrhea scores(visual analogue scale score,VAS)before and after treatment in the three groups: March,June,and December after treatment were all lower than those before treatment,and the dysmenorrhea score in group C It was significantly smaller than that of group A and group B,and the difference was statistically significant(P <0.05).3)Comparison of menstrual volume scores(Pictorial Blood Loss Assessment Chart,PBAC)before and after treatment in the three groups: Menstrual volume scores in March,June,and December after treatment were lower than those before treatment.The menstrual flow scores in group C were significantly lower than those in groups A and B,and the differences were statistically significant(P <0.05).4)Comparison of CA125 before treatment and at different times after treatment: 3months,6 months,and 12 months after treatment were lower than those before treatment.CA125 in group C was significantly smaller than that in groups A and B.The differences were statistically significant(P <0.05).ConclusionAfter using GnRH-a combined with HIFU,the changes in CA125,menstrual flow,dysmenorrhea,and lesion volume were more significant than those in the separate group,which can more effectively reduce the clinical symptoms of patients,reduce the lesionvolume,and improve the treatment efficiency.As a female patient with larger adenomyoma requiring conservative treatment,GnRH-a combined with HIFU may be a better choice.