Experimental Study Of High Intensity Focused Ultrasound In Treatment Of Abnormal Uterine Bleeding

Objective: Apply high intensity focused ultrasound(HIFU) in treatment of abnormal uterine bleeding(AUB), observe pathological changes of endometrium and PR, expression changes of ER before and after treatment, discuss its effect mechanism and prevent future relapse. By follow-up observations and comparison with high intensity focused ultrasound(HIFU) in treatment of abnormal uterine bleeding(AUB) and the clinical effect of transcervical resection of endometrium, assess its safety and efficacy of treatment.Method: chose 42 AUB patients who had no fertility requirements and voluntarily accepted to treat AUB by HIFU, 26 patients accepted transcervical resection of endometrium. HIFU treatment group applied HIFU to function layer, base layer, and even under 3 mm of muscle layer 3 mm for thermal radiation,divided into 2 ~ 3 treatment level, 1 /d. The two groups should do follow up observation for 12 months after treatment. Made a comparison of the total effect between HIFU treatment group and transcervical resection of endometrium group, including menstrual blood volume,Hb and the differences of color doppler ultrasonic examination of endometrium before and after treatment. And did diagnostic curettage within a month of before treatment and a year of after treatment to HIFU treatment group, took endometrial tissue to stain with HE to observe its changes of histomorphology and pathological type, tested ER, PR expression level by immunohistochemistry staining at the same time. Used SPSS 18.0 statistical software to analyze the data. The difference was statistically significant with P<0.05.Results: 1, Curative effect comparison of DUB treated by HIFU and transcervical resection of endometrium: 1.1 It showed the total effective rate of HIFU was 93%(39/42) and total effective rate of electrocision group was 88%(23/26) by observing the curative effect after posttreatment 12 months. HIFU treatment group has more significant effect. 1.2 the changes of menstruation quantity and hemoglobin of before and after treatment. After treatment in three, six and twelve months, compared with pre-operation, it showed difference in grading of PBAC and hemoglobin, which has the statistical significance. And the grade of PBAC after treatment in three, six and twelve months of HIFU treatment group was lower than electrocision group. 1.3 Before and after treatment of endometrial color doppler detection situation. There was significant difference(p<0.05) in endometrial color doppler detection situation between before and after treatment in HIFU treatment group and electrocision group. The electrocision group had significant difference(p<0.05) in thickness of intima compared to HIFU treatment group for it takes a long time to follow up. 2 pathological and immunohistochemical changes of HIFU in the treatment of AUB:2.1Pathological examination one and three months after HIFU treatment showed that the a portion of the glands suffered glandular cavity collapse, occlusion and necrosis in interstitium. With the growth of the granulation, healing the dead tissues, there followed a large amount of fibrous tissues hyperplasia. No obvious abnormal endometrial tissue has been found、 by scraping when 6 months after the treatment. 2.2Immunohistochemical detection results after 1 and 3 months of HIFU treatment showed that the positive expression rate in PR and ER of endometrial tissue is significantly lower than prior treatment, the difference is significative(Р < 0.05).Conclusion: 1, HIFU is more efficient than electrocision in the treatment of DUB. 2, HIFU in the treatment of AUB has the characteristics of less injury, high safety. 3, HIFU has the low long-term recurrence rate in the treatment of AUB. 4, HIFU is a new effective and safe method in the clinical treatment of AUB.