| High-intensity focused ultrasound(HIFU)has been recognized and accepted by more and more patients as a non-invasive treatment.HIFU has been used to treat adenomyosis for some time,and its safety and effectiveness have been confirmed.But due to the specificity of the disease,conservative surgery can not completely remove the lesion,thus there lies the risk of recurrence after HIFU treatment,which poses a challenge for chronic disease management after HIFU.Adenomyosis requires comprehensive treatment management,including not only the disease itself,but also the psychological problems caused by the disease,the behaviors and habits that are unfavorable to the disease.Therefore,it is necessary to evaluate the mental health status of patients to provide a basis for psychological intervention.Exercise intervention is the easiest and most economic way to manage chronic diseases,it may be of great significance to consolidate the effect of HIFU treatment and prevent disease recurrence.ObjectiveTo evaluate the mental health status of patients with adenomyosis by SCL-90 psychological scale;To evaluate the effect of HIFU ablation combined with exercise prescription therapy on dysmenorrhea symptoms remission in patients with adenomyosis.Material and methodsStudy 1 included 130 patients with adenomyosis and 95 women undergoing physical examination at Chongqing Haifu Hospital from October 2016 to May 2018.Everyone filled out the SCL-90 scale under the guidance of the medical staff.Analysis of differences in psychological status of patients with adenomyosis at different ages,marital status,and duration of disease,the higher the score of the scale,the worse the mental health level.The study 2 included 217 hospitalized patients with adenomyosis who underwent high-intensity focused ultrasound(HIFU)from January 2017 to March 2018 in Chongqing haifu hospital,all patients received exercise prescription education and guidance before surgery,and received exercise prescription at discharge(3-5 times a week,each time more than 30min,reaching at least 150 min/week of moderate-intensity aerobic exercise).Grouped according to the patient's implementation of exercise prescription after surgery,patients who followed the exercise prescription and exercised to meet the prescription criteria were classified as“exercise group”,and those who failure to follow the exercise prescription and no exercise were defined as“no exercise groups”.All patient's VAS scores of dysmenorrhea,dysmenorrhea relief,and uterine volume results were followed up and recorded at 3,6,and 12 months after surgery.Results1.The positive rate of SCL-90 total score was 27.7%in 130 patients with adenomyosis,and the positive rate of total score in 95 patients was6.3%.The total score and 10 factors in the adenomyosis group were higher than those in the physical examination group,indicating that the mental health level of patients with adenomyosis was significantly lower than that of the normal population.The scores of obsessive-compulsive symptoms,anxiety,and psychotic factors in SCL-90 of 30-39 years old adenomyosis patients were higher than those in 40-49 years old.There was no significant difference in the scores of SCL-90 and the scores of 10 factors in patients with adenomyosis with different marital status and different course of disease.2.This study included 217 patients with adenomyosis who met the inclusion and exclusion criteria.Among them,115 patients performed exercise prescriptions for at least 6 months during the follow-up period,which was classified as the“exercise group”,and the exercise prescription compliance rate was 53.0%;102 patients had no exercise after surgery and were included in the“no exercise group”.There was no significant difference between the two groups in the baseline data and the HIFU treatment ablation program(P>0.05),so the groups were comparable.3.The median VAS scores of pre-operation dysmenorrhea in the“exercise group”and the“no exercise group”were 7.0 and 7.5,respectively(P>0.05).At 3-,6-and 12-months follow-up time points after HIFU surgery,in the“exercise group”these were 3.0,2.0,and 3.0,respectively,while those in the“no exercise group”were 3.5,3.25,and 4.0,respectively.The VAS scores of the“exercise group”were lower than those of the“no exercise group”at 3-,6-,and 12-months after surgery(P<0.01).4.The median uterus volume of the preoperative in the“exercise group”and“no exercise group”were 264.329cm~3 and 268.630cm~3,respectively,and the difference was not statistically significant(P>0.05).At3-and 6-months after surgery,the median uterus volume reduction in the exercise group was 9.8(interquartile range,4.1-23.3)cm~3,16.1(interquartile range,3.1-58.9)cm~3,respectively,while the median uterus volume reduction in the“no exercise group”was 2.9(interquartile range,-4.7-18.1)cm~3,3.0(interquartile range,-7.2-21.0)cm~3,respectively.The uterus volume reduction in the“exercise group”was higher than that in the“no exercise group”at 3-and 6-months after operation,and the difference was statistically significant(P<0.01).Conclusion1.The mental health status of patients with adenomyosis is worse than that of normal people,and it is more obvious in young people,suggesting that young adenomyosis patients need to pay attention and assess psychological health status to provide psychological intervention programs.2.HIFU is a s effective treatment for adenomyosis.Combined with exercise prescription after HIFU,it can be more effective in reducing the VAS score of dysmenorrhea,relieving the symptoms of dysmenorrhea,improving the complete remission rate of dysmenorrhea,and may have a certain effect on promoting the reduction of uterine volume.3.Exercise prescription can be used as a rehabilitation treatment for uterine adenomyosis after HIFU via consolidating the effect of HIFU treatment and improving the self-evaluation of patients.It can be an important part of the long-term disease management model of adenomyosis. |
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