Ghezzi Fabio, Cromi Antonella, Bergamini Valentino, Scarperi Stefano, Bolis Pierfrancesco, Franchi Massimo
Department of Obstetrics and Gynecology, University of Insubria, Piazza Biroldi 1, 21100, Varese, Italy.
Surg Endosc. 2007 Nov;21(11):2081-5. doi: 10.1007/s00464-007-9307-8. Epub 2007 May 19.
Over the past decade an increasing demand for uterine-sparing treatment to manage symptomatic uterine myomas has become apparent in women's health care. A preliminary report showed that radiofrequency ablation (RFA) of uterine fibroids under laparoscopic guidance was a safe and effective minimally invasive approach with encouraging short-term results. The purpose of this study was to evaluate the midterm outcomes of radiofrequency ablation (RFA) of uterine myomas in terms of durability of symptom control and level of health-related quality of life.
Consecutive women with symptomatic uterine myomas, no plans for future pregnancy, and who declined hysterectomy were offered RFA ablation of uterine fibroids under laparoscopic guidance. Only 25 patients who completed at least the one-year follow-up assessment were included in the study group. Follow-up evaluations were scheduled at 1, 3, 6, 9, and 12 months and thereafter annually following the procedure. Improvement in myoma-related symptoms and impact on quality of life were assessed using a validated questionnaire (UFS-QOL).
The median number of myomas treated per patient was 1 (range = 1-3). The median baseline volume of the dominant myoma was 76.8 cm3 (range = 14.8-332.8). No intraoperative or postoperative complications occurred. The median follow-up time was 24 months, with nine women completing three years of follow-up. The median reduction in myoma volume was 68.8% and 77.9% at six months and one year, respectively. No further change in fibroid size was observed at two years and three years. One year after the procedure, one woman (4%) underwent hysterectomy for recurrence of fibroid-related symptoms. Quality-of-life measures showed significant and durable improvement compared with baseline.
RFA of symptomatic fibroids seems a valuable alternative to major surgery, with durable symptom relief for most patients and a low chance of recurrence at midterm.
在过去十年中，在女性医疗保健领域，对于采用保留子宫的方法来治疗有症状的子宫肌瘤的需求日益明显。一份初步报告显示，在腹腔镜引导下对子宫肌瘤进行射频消融（RFA）是一种安全有效的微创方法，短期效果令人鼓舞。本研究的目的是从症状控制的持久性和健康相关生活质量水平方面评估子宫肌瘤射频消融（RFA）的中期结果。
为有症状的子宫肌瘤、无未来妊娠计划且拒绝子宫切除术的连续女性患者，提供在腹腔镜引导下对子宫肌瘤进行射频消融治疗。研究组仅纳入了至少完成一年随访评估的25例患者。术后随访评估安排在1、3、6、9和12个月，此后每年进行。使用经过验证的问卷（UFS-QOL）评估肌瘤相关症状的改善情况以及对生活质量的影响。
每位患者治疗的肌瘤中位数为1个（范围 = 1 - 3个）。优势肌瘤的基线体积中位数为76.8 cm³（范围 = 14.8 - 332.8）。未发生术中或术后并发症。中位随访时间为24个月，9名女性完成了三年的随访。肌瘤体积在6个月和1年时的中位数减少分别为68.8%和77.9%。在2年和3年时未观察到肌瘤大小有进一步变化。术后1年，1名女性（4%）因肌瘤相关症状复发接受了子宫切除术。生活质量指标显示与基线相比有显著且持久的改善。
有症状肌瘤的射频消融似乎是大手术的一种有价值的替代方法，对大多数患者症状缓解持久，中期复发几率低。
