Clinical Study Of High Intensity Focused Ultrasound Combined With Percutaneous Ethanol Injection In The Treatment Of Adenomyosis

Objective:To investigate the clinical efficacy and safety using of the high intensity focused ultrasound(HIFU)combined with percutaneous ethanol injection(PEI)compared with HIFU alone in the treatment of adenomyosis.Methods :April in 2013-August in 2016,the patients with an average age of(40.88 ± 3.21)years underwent HIFU treatment of adenomyosis in our hospital were randomly divided into HIFU treatment group(HIFU group,n=31)and HIFU combined with PEI treatment group(PEI group,n=47).Comparison of the both groups about: ablation time,energy,intraoperative response,to determine the effect of ablation according to the MRI examination after 1 week of treatment.Results :There were all no significant differences in ages,symptoms,uterine size and lesion size between the both groups(P> 0.05).The treatment in HIFU group and PEI group were all success and no serious complication after treatment.In the PEI group,there were no complication associated with injection and were no complication such as peritoneal irritation sign caused by alcohol leakage.About the pain in postoperative abdominal or sacrococcygeal,PEI group(19.2%)was slightly higher than HIFU group(12.9%),but the difference was not significant(P > 0.05);about the vaginal bloody discharge,PEI group(23.4%)were slightly higher than HIFU group(9.7%),but there was also no significant difference(P > 0.05);During the treatment,2 cases of skin burn in HIFU group(6.5%)caused II degree burns and 1 cases of skin burn in PEI group(2.1%)caused I degree burns,and were all recovered after treatment 1 week later,there were no significant difference in both groups(P > 0.05).There were 32.2% in HIFU group and 46.8% in PEI group in the overall incidence of complications,and were no significant difference in both groups(P> 0.05).The complete ablation rate of lesion,PEI group was significantly higher than those in HIFU group(74.64% ± 16.3% vs 47.11% ± 11.2%)(P <0.05).In the Energy efficiency index,the HIFU group was significantly higher than those in the PEI group(8.65 + 3.21 J/mm3 vs 5.87 ± 2.54 J/mm3)(P < 0.05).About the time of irradiation,the time of ablation and the energy of treatment,PEI group were all significantly shorter than thosein HIFU group(P <0.05).Conclusion:HIFU combined with PEI has the same safety as HIFU alone in the treatment of adenomyosis.Furthermore,HIFU combined with PEI has the better efficacy than those in HIFU alone,and worthy of promotion.However,the study of the mechanism of ablation of HIFU and PEI may not only be a simple superposition of the two,but also may be related to the change of sound field distribution after PEI and the change of membrane resistance to sound pressure and temperature,which needs further study.