Clinical efficacy on treatment of abdominal wall endometriosis by different strategies

doi:10.3877/cma.j.issn.1673-5250.2020.03.015

Objective

To analyze clinical efficacy on treatment of abdominal wall endometriosis (AWE) by high-intensity focused ultrasound (HIFU) ablation and surgical resection.

Methods

From January 2015 to October 2018, 85 patients with AWE admitted to Nanchong Central Hospital and Affiliated Hospital of Zunyi Medical University were included into this study. According to different treatment methods, 29 patients treated with HIFU ablation were included in HIFU group while 56 patients who underwent resection of AWE lesions were included in surgery group. The age, body mass index (BMI), number of cesarean deliveries, number and diameter of lesions, length of hospital stay, irradiation time, treatment intensity and treatment energy of two groups were statistically compared by independent-samples t test. The treatment time, intraoperative blood loss and treatment power were statistically compared by Wilcoxon rank sum test. The chi-square test was used to statistically analyze the complete remission rate, clinical response rate, 1-year recurrence rate and complication rate. This study met the requirements of the World Medical Association Declaration of Helsinki revised in 2013.

Results

① The age of patients in HIFU group was (31.6±4.7) years old, which was younger than that of patients in surgery group (34.8±4.8) years old. There was significant difference between the two groups (t=-2.958, P=0.004). However, there were no significant differences in BMI, number of deliveries by cesarean section, interval from surgery to the occurrence of clinical symptoms, proportion of patients previously treated with drugs, proportion of patients with different degrees of pain, number of lesions, and lesion diameter between two groups (P>0.05). ② The median intraoperative blood loss and hospital stay of patients in HIFU group were 0 and (4.6±1.0) d, respectively, which were less than 10.0 mL (10.0-10.0 mL) and (6.3±1.8) d in HIFU group, and the differences between two groups had statistical significance (Z=-8.306, P<0.001; t=-5.692, P<0.001). The treatment time in HIFU group was 52.0 min (33.5-62.5 min), which was longer than the 30.0 min (25.0-43.8 min) in surgery group, and the difference between two groups was also statistically significant (Z=3.546, P<0.001). However, there were no significant differences in the complete remission rate, clinical response rate and 1-year recurrence rate between two groups (P>0.05).

Conclusions

HIFU ablation is safe and effective for AWE, but it still needs to be further verified by multicenter, prospective and randomized controlled trials.

Key words: Endometriosis, Abdominal wall endometriosis, High-intensity focused ultrasound ablation, Cicatrix, Abdominal wound pain, Recurrence, Comparative effectiveness research, Women

表1 2组AWE患者一般临床资料比较

组别	例数	年龄(岁，±s)	BMI (kg/m²，±s)	剖宫产术史(次，±s)	末次经腹子宫手术至出现临床症状间隔时间[月，M(P₂₅～P₇₅)]	既往因AWE接受药物治疗[例数(%)]
组别	例数	年龄(岁，±s)	BMI (kg/m²，±s)	剖宫产术史(次，±s)	末次经腹子宫手术至出现临床症状间隔时间[月，M(P₂₅～P₇₅)]	无	有
HIFU组	29	31.6±4.7	21.8±2.4	1.2±0.4	30(18～48)	22(75.9)	7(24.1)
手术组	56	34.8±4.8	21.8±2.3	1.1±0.3	24(12～45)	45(80.4)	11(19.6)
检验值		t＝—2.958	t＝0.297	t＝0.589	Z＝—0.824	χ² ＝ 0.231
P值		0.004	0.767	0.557	0.416	0.631
组别	例数	腹壁伤口周期性疼痛[例数(%)]			AWE数量(个，±s)	AWE直径(mm，±s)
组别	例数	轻度	中度	重度	AWE数量(个，±s)	AWE直径(mm，±s)
HIFU组	29	2(6.9)	23(79.3)	4(13.8)	1.07±0.26	26.6±7.0
手术组	56	12(21.4)	34(60.7)	10(17.9)	1.04±0.33	31.0±13.7
检验值		Z＝－0.793			t＝0.474	t＝－1.619
P值		0.428			0.636	0.109

表1 2组AWE患者一般临床资料比较

组别	例数	年龄(岁，±s)	BMI (kg/m²，±s)	剖宫产术史(次，±s)	末次经腹子宫手术至出现临床症状间隔时间[月，M(P₂₅～P₇₅)]	既往因AWE接受药物治疗[例数(%)]
组别	例数	年龄(岁，±s)	BMI (kg/m²，±s)	剖宫产术史(次，±s)	末次经腹子宫手术至出现临床症状间隔时间[月，M(P₂₅～P₇₅)]	无	有
HIFU组	29	31.6±4.7	21.8±2.4	1.2±0.4	30(18～48)	22(75.9)	7(24.1)
手术组	56	34.8±4.8	21.8±2.3	1.1±0.3	24(12～45)	45(80.4)	11(19.6)
检验值		t＝—2.958	t＝0.297	t＝0.589	Z＝—0.824	χ² ＝ 0.231
P值		0.004	0.767	0.557	0.416	0.631
组别	例数	腹壁伤口周期性疼痛[例数(%)]			AWE数量(个，±s)	AWE直径(mm，±s)
组别	例数	轻度	中度	重度	AWE数量(个，±s)	AWE直径(mm，±s)
HIFU组	29	2(6.9)	23(79.3)	4(13.8)	1.07±0.26	26.6±7.0
手术组	56	12(21.4)	34(60.7)	10(17.9)	1.04±0.33	31.0±13.7
检验值		Z＝－0.793			t＝0.474	t＝－1.619
P值		0.428			0.636	0.109

表2 2组AWE患者治疗情况比较

组别	例数	治疗时间[min，M(P₂₅～P₇₅)]	术中出血量[mL，M(P₂₅～P₇₅)]	住院时间(d，±s)	临床疗效[例数(%)]
组别	例数	治疗时间[min，M(P₂₅～P₇₅)]	术中出血量[mL，M(P₂₅～P₇₅)]	住院时间(d，±s)	CR	临床有效	1年复发
HIFU组	29	52.0(33.5～62.5)	0(0～0)	4.6±1.0	21(72.4)	28(96.6)	2(6.9)
手术组	56	30.0(25.0～43.8)	10.0(10.0～10.0)	6.3±1.8	51(91.0)	56(100.0)	1(1.8)
检验值		Z＝－3.546	Z＝－8.306	t＝－5.692	—	—	—
P值		<0.001	<0.001	<0.001	0.052	0.341	0.267

表2 2组AWE患者治疗情况比较

组别	例数	治疗时间[min，M(P₂₅～P₇₅)]	术中出血量[mL，M(P₂₅～P₇₅)]	住院时间(d，±s)	临床疗效[例数(%)]
组别	例数	治疗时间[min，M(P₂₅～P₇₅)]	术中出血量[mL，M(P₂₅～P₇₅)]	住院时间(d，±s)	CR	临床有效	1年复发
HIFU组	29	52.0(33.5～62.5)	0(0～0)	4.6±1.0	21(72.4)	28(96.6)	2(6.9)
手术组	56	30.0(25.0～43.8)	10.0(10.0～10.0)	6.3±1.8	51(91.0)	56(100.0)	1(1.8)
检验值		Z＝－3.546	Z＝－8.306	t＝－5.692	—	—	—
P值		<0.001	<0.001	<0.001	0.052	0.341	0.267

表3 HIFU组29例患者的HIFU消融治疗参数

项目	参数
治疗时间[min，M(P₂₅～P₇₅)]	52.0(33.5～62.5)
辐照时间(s，±s)	313.6±194.6
治疗设备输出功率[W，M(P₂₅～P₇₅)]	95.0(80.0～112.0)
治疗强度(s/h，±s)	316.3±109.9
治疗能量(J，±s)	31 807.7±19 655.1

表3 HIFU组29例患者的HIFU消融治疗参数

项目	参数
治疗时间[min，M(P₂₅～P₇₅)]	52.0(33.5～62.5)
辐照时间(s，±s)	313.6±194.6
治疗设备输出功率[W，M(P₂₅～P₇₅)]	95.0(80.0～112.0)
治疗强度(s/h，±s)	316.3±109.9
治疗能量(J，±s)	31 807.7±19 655.1

图2 AWE患者接受AWE病灶切除术后切口愈合不良

表4 2组AWE患者术后并发症发生率比较[例数(%)]

组别	例数	血尿	腹壁伤口处皮肤热痛	腹壁伤口处皮肤灼伤	腹壁伤口愈合不良	合计
HIFU组	29	1(3.4)	1(3.4)	1(3.4)	0(0)	3(10.3)
手术组	56	1(1.8)	0(0)	0(0)	3(5.4)	4(7.1)
χ²值		—	—	—	0.421^a	0.009^a
P值		1.000	0.341	0.341	0.516	0.926

表4 2组AWE患者术后并发症发生率比较[例数(%)]

组别	例数	血尿	腹壁伤口处皮肤热痛	腹壁伤口处皮肤灼伤	腹壁伤口愈合不良	合计
HIFU组	29	1(3.4)	1(3.4)	1(3.4)	0(0)	3(10.3)
手术组	56	1(1.8)	0(0)	0(0)	3(5.4)	4(7.1)
χ²值		—	—	—	0.421^a	0.009^a
P值		1.000	0.341	0.341	0.516	0.926

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