HIFU联合低频率电针治疗子宫腺肌病合并不孕症的临床观察

Clinical Observation on HIFU Combined with Low-Frequency Electroacupuncture in the Treatment of Adenomyosis Complicated with Infertility

摘要: 目的：评价高强度聚焦超声(HIFU)联合低频率电针治疗气滞血瘀型子宫腺肌病(AM)合并不孕症的临床疗效，重点观察子宫内膜容受性改善、痛经缓解及妊娠率提升效果，为临床优化治疗方案提供循证依据。方法：选取2022年1月至2024年12月贵州中医药大学第二附属医院妇科收治的气滞血瘀型AM合并不孕症患者68例，按随机数字表法分为单纯HIFU组(34例)与HIFU + 低频率电针组(联合组，34例)。单纯HIFU组采用JC200D型HIFU系统行病灶消融治疗；联合组在HIFU治疗后，于月经第5日开始低频率电针治疗(选穴关元、子宫、气海等，连续波2 Hz，每次30 min，隔日1次，共3个月经周期)。比较两组治疗前及治疗后3个月经周期的子宫内膜容受性指标(容积、厚度、子宫动脉RI、PI、S/D)、血清血管内皮生长因子(VEGF)水平、痛经VAS评分，随访治疗后3~15个月临床妊娠率，并记录安全性事件。结果：① 子宫内膜容受性：治疗后联合组子宫内膜容积(7.5 ± 0.9 mL)、厚度(8.2 ± 1.1 mm)显著高于单纯HIFU组(6.8 ± 0.8 mL、7.5 ± 1.0 mm)，子宫动脉RI (0.65 ± 0.03)、PI (1.68 ± 0.15)、S/D (3.9 ± 0.4)显著低于单纯HIFU组(0.69 ± 0.04, 1.82 ± 0.17, 4.3 ± 0.5)，差异均有统计学意义(P < 0.05)；② VEGF与痛经：治疗后联合组血清VEGF (21.3 ± 5.8 pg/mL)、痛经VAS评分(2.1 ± 0.8分)显著低于单纯HIFU组(25.6 ± 6.2 pg/mL、2.8 ± 0.9分)，差异有统计学意义(P < 0.05)；③ 妊娠率：随访期内联合组妊娠率(32.4%, 11/34)高于单纯HIFU组(17.6%, 6/34)，但差异无统计学意义(χ² = 2.283, P = 0.131)；④ 安全性：联合组出现2例轻微晕针，经平卧休息后缓解，无血肿、感染等严重不良事件，两组安全性良好。结论：HIFU联合低频率电针可显著改善气滞血瘀型AM合并不孕症患者的子宫内膜容受性与痛经症状，安全性高，虽妊娠率未达统计学差异，但呈提升趋势，值得临床进一步推广。

Abstract: Objective: To evaluate the clinical efficacy of High-Intensity Focused Ultrasound (HIFU) combined with low-frequency electroacupuncture in the treatment of Adenomyosis (AM) of qi stagnation and blood stasis type complicated with infertility, with a focus on observing the effects of improving endometrial receptivity, relieving dysmenorrhea, and increasing pregnancy rate, so as to provide an evidence-based basis for optimizing clinical treatment regimens. Methods: A total of 68 patients with AM of qi stagnation and blood stasis type complicated with infertility admitted to the Department of Gynecology, the Second Affiliated Hospital of Guizhou University of Traditional Chinese Medicine from January 2022 to December 2024 were selected. They were divided into the HIFU alone group (34 cases) and the HIFU + low-frequency electroacupuncture group (combined group, 34 cases) by random number table method. The HIFU alone group received lesion ablation therapy using the JC200D HIFU system; the combined group received low-frequency electroacupuncture treatment starting from the 5th day of menstruation after HIFU treatment (acupoints selected: Guanyuan, Zigong, Qihai, etc., continuous wave at 2 Hz, 30 minutes each time, once every other day, for a total of 3 menstrual cycles). The endometrial receptivity indicators (volume, thickness, uterine artery RI, PI, S/D), serum Vascular Endothelial Growth Factor (VEGF) level, and dysmenorrhea VAS score were compared between the two groups before treatment and 3 menstrual cycles after treatment. The clinical pregnancy rate was followed up for 3~15 months after treatment, and safety events were recorded. Results: ① Endometrial receptivity: After treatment, the endometrial volume (7.5 ± 0.9 mL) and thickness (8.2 ± 1.1 mm) in the combined group were significantly higher than those in the HIFU alone group (6.8 ± 0.8 mL, 7.5 ± 1.0 mm), while the uterine artery RI (0.65 ± 0.03), PI (1.68 ± 0.15), and S/D (3.9 ± 0.4) in the combined group were significantly lower than those in the HIFU alone group (0.69 ± 0.04, 1.82 ± 0.17, 4.3 ± 0.5), with statistically significant differences (P < 0.05); ② VEGF and dysmenorrhea: After treatment, the serum VEGF (21.3 ± 5.8 pg/mL) and dysmenorrhea VAS score (2.1 ± 0.8 points) in the combined group were significantly lower than those in the HIFU alone group (25.6 ± 6.2 pg/mL, 2.8 ± 0.9 points), with statistically significant differences (P < 0.05); ③ Pregnancy rate: During the follow-up period, the pregnancy rate in the combined group (32.4%, 11/34) was higher than that in the HIFU alone group (17.6%, 6/34), but the difference was not statistically significant (χ² = 2.283, P = 0.131); ④ Safety: There were 2 cases of mild needle syncope in the combined group, which were relieved after lying flat and resting; no serious adverse events such as hematoma or infection occurred, and both groups had good safety. Conclusion: HIFU combined with low-frequency electroacupuncture can significantly improve endometrial receptivity and dysmenorrhea symptoms in patients with AM of qi stagnation and blood stasis type complicated with infertility, with high safety. Although the pregnancy rate does not reach a statistically significant difference, it shows an increasing trend, which is worthy of further clinical promotion.