高强度聚焦超声对子宫肌瘤患者肌瘤残留、氧化应激的影响

摘要/Abstract

摘要： 目的探讨高强度聚焦超声（HIFU）治疗子宫肌瘤的效果及对肌瘤残留、氧化应激的影响。方法选择2020年8月—2023年8月烟台市莱阳中心医院收治的84例子宫肌瘤患者作为研究对象,按随机数表法将其分为对照组与研究组,每组42例。对照组行腹腔镜子宫肌瘤剔除术,研究组行HIFU治疗,比较两组手术指标、并发症发生率、肌瘤残留率、氧化应激指标[丙二醛（MDA）、晚期氧化蛋白产物（AOPP）、活性氧（ROS）水平]、免疫功能指标[T淋巴细胞（CD3⁺、CD4⁺、CD4⁺/CD8⁺）]。结果与对照组比较,研究组手术时间、术后排气时间、住院时间更短,术中出血量更少,差异有统计学意义（P<0.05）。与对照组比较,研究组术后并发症发生率、肌瘤残留率更低,差异有统计学意义（P<0.05）。术前,两组MDA、AOPP、ROS水平比较,差异无统计学意义（P>0.05）,与术前比较,两组术后1 d的MDA、AOPP、ROS水平均升高,但与对照组比较,研究组MDA、AOPP、ROS水平更低,差异有统计学意义（P<0.05）。术前,两组CD3⁺、CD4⁺、CD4⁺/CD8⁺水平比较,差异无统计学意义（P>0.05）,与术前比较,两组术后1 d的CD3⁺、CD4⁺、CD4⁺/CD8⁺水平均降低,但与对照组比较,研究组CD3⁺、CD4⁺、CD4⁺/CD8⁺水平更高,差异有统计学意义（P<0.05）。结论 HIFU治疗子宫肌瘤的肌瘤残留率低,并发生发生率低,对氧化应激、免疫功能影响较小,治疗安全性有效。

关键词: 子宫肌瘤, 高强度聚焦超声, 肌瘤残留, 氧化应激, 并发症, 免疫功能

Abstract: Objective To explore the effect of ultrasound-guided high-intensity focused ultrasound (HIFU) on the treatment of uterine fibroids and its impact on residual fibroids and oxidative stress. Methods 84 patients with uterine fibroids, admitted to Yantai Laiyang central hospital from August 2020 to August 2023, were randomly divided into two groups. The control group underwent laparoscopic myomectomy, while the study group received HIFU treatment. Surgical outcomes, complication rates, residual fibroid rates, and oxidative stress markers [malondialdehyde (MDA), advanced oxidative protein products (AOPP), reactive oxygen species (ROS)] were evaluated, and immune function markers [Tlymphocytes (CD3⁺, CD4⁺, CD4⁺/CD8⁺)] were also assessed into two groups. Results Compared with the control group, the study group had shorter surgical time, postoperative exhaust time, hospital stay, and less intraoperative bleeding, with statistically significant differences (P<0.05). Compared with the control group, the incidence of postoperative complications and residual fibroids in the study group were lower, and the difference was statistically significant (P<0.05). There was no statistically significant difference (P>0.05) in MDA, AOPP, and ROS levels between the two groups before surgery. However, compared to before surgery, the MDA, AOPP, and ROS levels in the two groups increased on the first day after surgery, and the difference was statistically significant (P<0.05). However, compared to the control group, the MDA, AOPP, and ROS levels in the study group were lower, and the difference was statistically significant (P<0.05). There was no statistically significant difference (P>0.05) in the comparison of CD3⁺, CD4⁺, and CD4⁺/CD8⁺between the two groups before surgery. Compared with before surgery, the levels of CD3⁺, CD4⁺, and CD4⁺/CD8⁺in the two groups decreased 1 day after surgery. However, compared with the control group, the levels of CD3⁺, CD4⁺, and CD4⁺/CD8⁺in the study group were higher, and the difference was statistically significant (P<0.05). Conclusion :Ultrasound-guided HIFU treatment of uterine fibroids has a low residual rate of fibroids and a low incidence of fibroids, which has little effect on oxidative stress and immune function, and is safe and effective.

Key words: uterine fibroids, ultrasound-guided high-intensity focused ultrasound, residual fibroids, oxidative stress, complications, immunologic function

中图分类号:

R737.33

王云, 赵文宇. 高强度聚焦超声对子宫肌瘤患者肌瘤残留、氧化应激的影响[J]. 中华养生保健, 2024, 42(17): 191-194.

WANG Yun, ZHAO Wen-yu. The Effect of High-Intensity Focused Ultrasound on Residual Fibroids and Oxidative Stress in Patients with Uterine Fibroids[J]. ZHONGHUA YANGSHENG BAOJIAN, 2024, 42(17): 191-194.

参考文献

[1] 陈宇东,梁少凤.经脐单孔腹腔镜与传统多孔腹腔镜手术治疗子宫肌瘤的疗效及术后康复效果比较[J].现代肿瘤医学,2021,29(10):1760-1765.
[2] 窦勇,王福建.超声引导下自凝刀射频消融术对子宫肌瘤患者血清激素,氧化应激及免疫功能的影响[J].中国妇幼保健,2020,35(17):3304-3307.
[3] 金男,杨洪艳,裴会,等.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].现代生物医学进展,2022,22(18):3454-3458.
[4] 子宫肌瘤的诊治中国专家共识专家组.子宫肌瘤的诊治中国专家共识[J].中华妇产科杂志,2017,52(12):793-800.
[5] 寿迪燕,傅文英,吴兵.阴道超声引导下腹腔镜手术治疗子宫肌瘤的临床效果及对肌瘤残留、复发情况的研究[J].浙江创伤外科,2023,28(9):1625-1627.
[6] YARMOLINSKAYA M, POLENOV N I, KUNITSA V V.Uterine fibroids: the role of signaling pathways in the pathogenesis. A literature review[J]. Journal of obstetrics and women's diseases,2020,69(5):113-124.
[7] 王常利,谢瑞瑞,徐永妮.腹腔镜下子宫肌瘤剔除术对患者手术部位感染,炎症应激指标,IGF-1,AOPP水平及宫颈微循环的影响[J].临床和实验医学杂志,2023,22(15):1621-1625.
[8] 马强,陈雯,吴乾凤,等.术中超声应用于腹腔镜子宫肌瘤剔除术对肌瘤残留及复发率的影响分析[J].中国生育健康杂志,2020,31(2):155-157.
[9] 杭中霞,朱静.高强度聚焦超声子宫肌瘤消融术联合GnRH-a治疗子宫肌瘤患者的效果及对性激素,子宫内膜容受性的影响[J].临床医学研究与实践,2023,8(24):82-85.
[10] LIAO P, JIANG J, ZENG Y H, et al.Comparison of outcomes of hysteroscopic myomectomy of type 2 submucous fibroids greater than 4 cm in diameter via pretreatment with HIFU or GnRH-a[J]. International Journal of Hyperthermia,2021,38(1):183-188.
[11] 赵巧霞,王宝金.高强度聚焦超声子宫肌瘤消融术对子宫内膜容受性,性激素水平及妊娠结局的影响[J].安徽医药,2019,23(5):942-945.
[12] 尤俊芬. 高强度聚焦超声消融术治疗不同大小子宫肌瘤的疗效及对患者妊娠结局的影响[J].实用癌症杂志,2020,35(4):656-659.
[13] 窦勇,王福建.超声引导下自凝刀射频消融术对子宫肌瘤患者血清激素,氧化应激及免疫功能的影响[J].中国妇幼保健,2020,35(17):3304-3307.
[14] 李小娟,樊梦,邓晓红.高强度聚焦超声子宫肌瘤消融术治疗子宫肌瘤的效果及对子宫内膜容受性,MMP-2,MMP-9水平的影响[J].临床医学研究与实践,2023,8(18):37-40.
[15] 江浩,魏米琳,石英娜.超声引导下高强度聚焦超声治疗子宫肌瘤疗效及对患者氧化应激和免疫功能影响[J].中国计划生育学杂志,2022,30(5):1031-1035.