中文摘要：

目的 比较HIFU治疗弥漫型和局限型子宫腺肌病的近远期疗效。方法 收集308例接受HIFU治疗的子宫腺肌病患者，依据术前MRI将其分为弥漫组和局限组，计算消融率及消融发生率，并评估2组患者术前、术后痛经及月经量情况。结果 共297例患者进行了有效随访，随访时间1~50个月，其中弥漫组177例，局限组120例。297例患者消融发生率为99.33%（295/297），弥漫组及局限组消融率分别为（26.00±13.36）%、（44.32±19.93）%。2组患者术后痛经及月经量评分与术前比较均有明显降低（P均〈0.05）。痛经症状总缓解率在术后3、6、12、24及36个月分别为92.96%（264/284）、86.18%（237/275）、73.51%（197/268）、60.71%（136/224）及46.83%（59/126）；各随访时段局限组痛经缓解率均高于弥漫组，且在术后6、24及36个月差异有统计学意义（P〈0.05）。月经量过多症状总缓解率在术后3、6、12、24及36个月分别为87.38%（187/214）、83.09%（172/207）、68.63%（140/204）、63.64%（105/165）及45.92%（45/98）；各随访时段局限组均高于弥漫组，但差异均无统计学意义（P均〉0.05）。结论 HIFU治疗子宫腺肌病疗效显著，局限型与弥漫型近期疗效相当，远期疗效局限型优于弥漫型。

英文摘要：

Objective To compare the short-term and long-term efficacy of HIFU in treatment of diffuse and focal adenomyosis. Methods A total of 308 patients with adenomyosis who accepted HIFU ablation were collected. According to preprocedural MRI, the patients were divided into diffuse and focal group. The non-perfused volume ratio （NPVR） and the incidence of ablation were calculated. Preprocedural and postprocedural situation of dysmenorrhea and menorrhagia were evaluated. Results Effective follow-up were performed in 297 cases. The follow-up time was 1-50 months. There were 177 cases in diffuse group, while 120 cases in focal group. The incidence of ablation among 297 patients was 99.33% （295/297）. The NPVR of diffuse and focal group were （[26.00±13.36]%） and （[44.32±19.93]%）, respectively. The dysmenorrhea and menorrhagia score of postprocedure were significantly lower than those of preprocedure in two groups （both P〈0.05）. The total remission rate of dysmenorrhea in 3, 6, 12, 24 and 36 months after ablation were 92.96% （264/284）, 86.18% （237/275）, 73.51% （197/268）, 60.71%（136/224）, 46.83% （59/126）, respectively. The remission rate of dysmenorrhea of focal group was higher than that of diffuse group in each follow-up period, while significant differences were observed in 6, 24 and 36 months （P〈0.05）. The total remission rate of menorrhagia in 3, 6, 12, 24 and 36 months after ablation were 87.38% （187/214）, 83.09% （172/207）, 68.63% （140/204）, 63.64% （105/165）, 45.92% （45/98）, respectively. The remission rate of menorrhagia of focal group was higher than those of diffuse group in each follow-up period, while no significant difference was observed between two groups （all P〉0.05）. Conclusion HIFU is significantly effective for adenomyosis, the short-term efficacy of focal and diffuse type are familiar, while the long-term efficacy of focal type is better than that of diffuse type.