目的 评价高强度聚焦超声（high intensity focused ultrasound， HFIU）病灶及子宫内膜联合消融治疗子宫腺肌病（adenomyosis， AM）合并月经过多（heavy menstrual bleeding， HMB）患者的疗效及安全性。 方法 选取2020年7月至2022年9月于成都中医药大学附属医院妇科海扶中心行HIFU治疗的AM合并HMB患者199例，按消融范围分为两组，联合消融组80例行病灶及子宫内膜联合消融（内膜消融率≥ 30%），病灶消融组119例行单纯病灶消融，对两组患者进行1∶1倾向性评分匹配，得到每组59例患者。随访6个月，比较两组患者术前和术后6个月的临床表现（月经量、痛经程度、子宫及病灶体积）、生存质量（MS-QOL、UFS-QOL）及术后不良反应。 结果 术后6个月，两组患者月经量、痛经程度、子宫及病灶体积、MS-QOL评分及UFS-QOL评分较术前均有改善（P < 0.05）。与病灶消融组相比，联合消融组月经量、痛经程度、MS-QOL评分明显降低（P < 0.05），但子宫及病灶体积和UFS-QOL评分差异无统计学意义（P > 0.05）。两组各项不良反应发生率比较差异无统计学意义（P > 0.05），但联合消融组阴道流血和流液时间较病灶消融组长（P < 0.05）。 结论 HIFU病灶及子宫内膜联合消融治疗AM合并HMB患者可有效减少月经量、缓解痛经、改善生存质量，虽增加了AM患者HIFU术后阴道流血和流液的时间，但经过合理的对症处理可有效预防感染等不良后果的发生。

Objective To evaluate the efficacy and safety of high intensity focused ultrasound （HFIU） combined with endometrial ablation in the treatment of adenomyosis （AM） patients with heavy menstrual bleeding （HMB）. Method A total of 199 patients with AM combined with HMB who underwent HIFU treatment at the Obstetrics and Gynecology Center of Affiliated Hospital of Chengdu University of TCM from July 2020 to September 2022 were selected and divided into two groups according to the ablation range. The combined ablation group included 80 cases with lesion and endometrial ablation （endometrial ablation rate ≥ 30%）， while the lesion ablation group 119 cases with simple lesion ablation. A 1∶1 propensity score matching was performed on the two groups， resulting in 59 patients in each group. A 6-month follow-up was conducted. The clinical manifestations （menstrual volume， degree of dysmenorrhea， uterine and lesion volume）， quality of life （MS-QOL， UFS-QOL）， and postoperative adverse reactions between the two groups before and 6 months after surgery was compared. Results Menstrual volume， degree of dysmenorrhea， uterine and lesion volume， MS-QOL score， and UFS-QOL score of the both groups were improved 6 months after surgery， when compared to those before surgery （P < 0.05）. Significantly reduced menstrual volume， degree of dysmenorrhea， and lower MS-QOL score were observed in the combined ablation group when compared with the lesion ablation group （P < 0.05）， but there was no statistical significance in uterine and lesion volume and UFS-QOL score （P > 0.05）. There was no difference in the incidence of adverse reactions between the two groups （P > 0.05）， but the combined ablation group had longer vaginal bleeding and fluid flow time （P < 0.05）. Conclusion The combined HIFU and endometrial ablation can effectively reduce menstrual flow， alleviate dysmenorrhea， and improve quality of life in patients with AM combined with HMB. Although it increases vaginal bleeding and fluid flow time， reasonable symptomatic management can effectively prevent the occurrence of adverse consequences such as infection.