Marret H, Bleuzen A, Guérin A, Lauvin-Gaillard M-A, Herbreteau D, Patat F, Tranquart F
Service de gynécologie, CHU de Bretonneau, Tours, France.
Gynecol Obstet Fertil. 2011 Jan;39(1):12-20. doi: 10.1016/j.gyobfe.2010.08.038. Epub 2010 Dec 24.
Many women with myomas desire uterine conservation. Magnetic resonance-guided focused ultrasound surgery (MRgFUS) is a new non-invasive therapy. We describe our early results regarding efficacy and safety of MRgFUS for the treatment of uterine leiomyomas.
Fifty-two French women, over 18 years of age, who were candidates for surgical myomectomy, hysterectomy or uterine artery embolization due to symptomatic myomas were treated by MRgFUS (ExAblate 2000(®), InSightec) and followed up for at least 6 months. Intramural or subserous myomas with a size between 4-12 cm and a T2 low intensity MRI image were selected in women with no abdominal scar and no bowel interposition. The modified symptom severity score (SSS) was examined before and after the treatment at 6 months. Second treatment rate during the first follow-up year was reported.
No serious complications were recorded during the treatments or follow-up period. Seven women had initial failure mostly because of bowel interposition, six of them had uterine artery embolisation. The mean modified SSS value for patients before MRgFUS was 41/100 and the values diminished significantly to a mean value of 22/100. A total of 65% of women had a reduction of at least 10 points (n=22) (initial score of 41 [29; 62] and 22 [16; 46] at 6 month follow-up). Good correlation was observed between myomas destruction and the symptoms score. During the follow-up period, ten patients (19%) required invasive interventions (six hysterectomies, two embolisations and two myomectomies). The average reduction in myoma volume determined by MR imaging at 6 months after treatment was 14%. This volume reduction is poorly correlated with the myoma's treated volume of 36.4% (6-74%).
MRgFUS can safely be used for symptomatic treatment and avoid the need for surgical intervention in most patients. Additional follow-up is needed to determine the long-term durability of this promising non-invasive approach and to obtain reimbursement.
许多患有子宫肌瘤的女性希望保留子宫。磁共振引导聚焦超声手术（MRgFUS）是一种新的非侵入性治疗方法。我们描述了MRgFUS治疗子宫平滑肌瘤的有效性和安全性的早期结果。
52名年龄超过18岁、因有症状的肌瘤而适合进行手术切除肌瘤、子宫切除或子宫动脉栓塞术的法国女性接受了MRgFUS（ExAblate 2000(®)，InSightec）治疗，并随访至少6个月。选择壁间或浆膜下肌瘤，大小在4 - 12厘米之间，T2加权磁共振成像呈低信号，且无腹部瘢痕和肠粘连的女性。在治疗前和治疗后6个月检查改良症状严重程度评分（SSS）。报告首次随访年内的二次治疗率。
治疗期间或随访期内未记录到严重并发症。7名女性最初治疗失败，主要原因是肠粘连，其中6人接受了子宫动脉栓塞术。MRgFUS治疗前患者的平均改良SSS值为41/100，显著降至平均22/100。共有65%的女性至少降低了10分（n = 22）（初始评分为41 [29; 62]，6个月随访时为22 [16; 46]）。观察到肌瘤破坏与症状评分之间有良好的相关性。随访期间，10名患者（19%）需要进行侵入性干预（6例子宫切除术、2例栓塞术和2例肌瘤切除术）。治疗后6个月通过磁共振成像确定的肌瘤体积平均减少14%。这种体积减少与治疗的肌瘤体积36.4%（6 - 74%）相关性较差。
MRgFUS可安全用于有症状的治疗，且在大多数患者中可避免手术干预。需要进一步随访以确定这种有前景的非侵入性方法的长期疗效并获得报销。
