高强度聚焦超声联合低频率电针治疗气滞血瘀型子宫腺肌病合并不孕症的临床研究

Clinical Study 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，重点观察子宫体积改变情况及痛经缓解效果，为临床优化治疗方案提供循证依据。方法：选取2023年1月至2023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个月经周期的子宫体积、痛经视觉模拟评分(VAS)，并记录治疗期间安全性事件。结果：治疗前两组子宫体积、痛经VAS评分比较，差异无统计学意义(P > 0.05)；治疗后3个月经周期，两组上述指标均较治疗前显著改善(P < 0.001)，且联合组改善幅度优于单纯HIFU组(P < 0.05)：联合组子宫体积为(162.3 ± 25.7) cm³，显著小于单纯HIFU组的(185.6 ± 28.3) cm³；联合组痛经VAS评分为(2.1 ± 0.8)分，显著低于单纯HIFU组的(2.8 ± 0.9)分。安全性方面，联合组出现2例轻微晕针，经平卧休息后缓解；单纯HIFU组出现1例轻微腹壁胀痛，调整治疗参数后缓解，两组均无血肿、感染等严重不良事件。结论：HIFU联合低频率电针可显著缩小气滞血瘀型AM合并不孕症患者的子宫体积、缓解痛经症状，且安全性高，值得临床推广应用。

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 changes in uterine volume and the effect of relieving dysmenorrhea, 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 2023 to December 2023 were selected. They were divided into the HIFU alone group (34 cases) and the HIFU + low-frequency electroacupuncture group (combined group, 34 cases) using the random number table method. The HIFU alone group received lesion ablation therapy with 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 per session, once every other day, for a total of 3 menstrual cycles). The uterine volume and dysmenorrhea Visual Analogue Scale (VAS) score were compared between the two groups before treatment and 3 menstrual cycles after treatment, and safety events during the treatment period were recorded. Results: Before treatment, there were no statistically significant differences in uterine volume or dysmenorrhea VAS score between the two groups (P > 0.05). At 3 menstrual cycles after treatment, both indicators in both groups were significantly improved compared with those before treatment (P < 0.001), and the improvement in the combined group was superior to that in the HIFU alone group (P < 0.05): the uterine volume of the combined group was (162.3 ± 25.7) cm³, which was significantly smaller than that of the HIFU alone group [(185.6 ± 28.3) cm³]; the dysmenorrhea VAS score of the combined group was (2.1 ± 0.8) points, which was significantly lower than that of the HIFU alone group [(2.8 ± 0.9) points]. In terms of safety, 2 cases of mild needle syncope occurred in the combined group, which were relieved after lying flat and resting; 1 case of mild abdominal wall distending pain occurred in the HIFU alone group, which was relieved after adjusting the treatment parameters. No serious adverse events such as hematoma or infection occurred in either group. Conclusion: HIFU combined with low-frequency electroacupuncture can significantly reduce the uterine volume and relieve dysmenorrhea symptoms in patients with AM of qi stagnation and blood stasis type complicated with infertility, with high safety, and is worthy of clinical promotion and application.