摘要目的观察高强度聚焦超声（HIFU）消融治疗有生育要求的子宫腺肌病患者的疗效及妊娠结局。方法自2010年10月至2015年10月，68例有生育要求的子宫腺肌病患者在遂宁市中心医院接受HIFU消融治疗，其中，56例以痛经为主要表现，41例有不良孕产史。回顾性分析患者的临床资料，观察HIFU消融治疗的疗效及患者的妊娠结局。结果 HIFU消融治疗后，54例子宫腺肌病患者成功妊娠，中位妊娠时间为治疗后10个月（范围：1~31个月）；其中21例已足月分娩，妊娠中及分娩时无子宫破裂发生，新生儿健康。54例妊娠患者，HIFU消融治疗前与治疗后1、3、6个月病灶体积[分别为（34±23）、（23±15）、（20±17）、（20±12）cm3]、经量增多评分[分别为（2.6±1.7）、（1.7±0.8）、（1.4±0.6）、（1.3±0.6）分]、痛经评分[分别为（1.4±0.9）、（0.9±0.7）、（0.6±0.5）、（0.9±0.7）分]分别比较，差异均有统计学意义（P<0.05）。54例HIFU消融治疗后妊娠的患者中，20例（37%，20/54）发生自然流产，与治疗前本组患者的自然流产发生率（43%，23/54）比较，虽然发生率降低，但差异无统计学意义（P>0.05）；20例自然流产患者与21例已分娩的患者比较，两者在年龄、病程、治疗前病灶体积、消融率、治疗前后症状评分等方面无差异（P>0.05）。结论 HIFU消融治疗能改善有生育要求的子宫腺肌病患者的临床症状，且不增加妊娠及分娩时并发症的发生率。

abstractsObjective To investigate the symptom improvement and pregnancy outcomes of patients with adenomyosis after treatment with high intensity focused ultrasound (HIFU) ablation. Methods From October 2010 to October 2015, 68 patients with adenomyosis who wish to get pregnancies were treated with HIFU ablation in Suining Central Hospital. Among these patients, 56 presented with dysmenorrhea, 11 presented with menorrhagia, and 1 patient complained both; 41 of them had histories of abnormal pregnancy. The clinical data were analyzed retrospectively. Results Fifty-four patients got pregnancy at the median of 10 months(range:1 to 31 months) after HIFU ablation, and 21 of them had delivered healthy babies. No uterine rupture occurred during gestation or delivery, and the newborn babies were healthy. Dysmenorrhea and menorrhagia in the patients who had pregnancies after HIFU ablation treatment were significantly relieved. The average menstruation volume score before and 1, 3, 6-month post-HIFU were 2.6 ± 1.7, 1.7 ± 0.8, 1.4 ± 0.6, 1.3 ± 0.6, respectively (P<0.05). The menstruation pain score before and 1, 3, 6-month after HIFU were 1.4 ± 0.9, 0.9 ± 0.7, 0.6 ± 0.5, and 0.9 ± 0.7, respectively (P<0.05). The volume of the adenomyotic lesions before and after HIFU at 1, 3, 6 month were (34±23), (23±15), (20± 17), (20 ± 12) cm3 (P<0.05). Although the spontaneous abortion rate was decreased after HIFU ablation treatment, there was no significant difference between the preoperative and postoperative [43% (23/54) versus 37%(20/54), P>0.05]. However, 20 of the 54 patients had spontaneous abortion, compared with 21 patients who had delivered babies, there were no significant statistical difference in terms of age, duration of disease, lesion size, non-perfused volume ratio, as well as the symptom scores before and after HIFU ablation treatment. Conclusions HIFU ablation treatment is effective in improving symptoms of patients with&nbsp;adenomyosis. Based on our results, HIFU ablation treatment maybe also help to improve the pregnancy outcomes of patients with adenomyosis, but further studies are needed.