| 摘要: |
| 子宫腺肌病是妇科常见的良性疾病，可导致痛经、月经过多、慢性盆腔痛及不孕等问题。传统子宫切除术疗效确切，但难以满足年轻患者及有保留子宫、生育需求患者的治疗需求。近年来，高强度聚焦超声（HIFU）、射频消融（RFA）和微波消融（MWA）等热消融技术逐渐应用于子宫腺肌病治疗，为保留子宫治疗提供了新的选择。现有研究表明，影像引导热消融能够有效改善痛经和月经过多，缩小病灶及子宫体积，并在部分患者中获得良好的生育结局。然而，与子宫肌瘤不同，子宫腺肌病病灶缺乏明确边界，与正常肌层呈浸润性交错分布，其治疗不仅需要关注症状改善，还应兼顾重要结构保护、生育需求及长期疾病管理。本文围绕热消融技术特点、临床决策、症状控制、生育保护、联合治疗及安全性等方面进行综述，为子宫腺肌病热消融治疗的临床实践提供参考。 |
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GONG XIAOMING
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Hebei Maternity Hospital
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| Abstract: |
| Adenomyosis is a common benign gynecological disorder associated with dysmenorrhea, heavy menstrual bleeding, chronic pelvic pain, and infertility. Although hysterectomy provides definitive symptom relief, it is unsuitable for women who desire uterine preservation and future fertility. In recent years, thermal ablation techniques, including high-intensity focused ultrasound (HIFU), radiofrequency ablation (RFA), and microwave ablation (MWA), have increasingly been used in the management of adenomyosis, offering minimally invasive alternatives for uterus-preserving treatment. Current evidence indicates that image-guided thermal ablation can effectively alleviate symptoms, reduce lesion and uterine volumes, and provide favorable reproductive outcomes in selected patients. However, unlike uterine fibroids, adenomyotic lesions are characterized by indistinct margins and infiltrative growth within the myometrium, making treatment strategies more complex. In addition to symptom relief, preservation of critical uterine structures, reproductive potential, and long-term disease management should be considered. This review summarizes the characteristics of thermal ablation techniques and discusses clinical decision-making, symptom control, fertility preservation, combination therapy, and safety, with the aim of providing a reference for the clinical management of adenomyosis treated with thermal ablation. |
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