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磁共振引导聚焦超声手术(MRgFUS)治疗有症状子宫肌瘤的临床疗效

[Clinical outcome of magnetic-resonance-guided focused ultrasound surgery (MRgFUS) in the treatment of symptomatic uterine fibroids].

作者信息

Kamp J E-K, David M, Scheurig-Muenkler C, Hengst S, Beck A

机构信息

Klinik für Radiologie, Charité - Universitätsmedizin Berlin.

出版信息

Rofo. 2013 Feb;185(2):136-43. doi: 10.1055/s-0032-1325512. Epub 2012 Nov 29.

DOI:10.1055/s-0032-1325512
PMID:23196835
Abstract

PURPOSE

To investigate the clinical outcome of magnetic-resonance-guided focused ultrasound surgery (MRgFUS) treatment for symptomatic uterine fibroids in premenopausal women using the validated USF-QOL (Uterine Fibroid Symptom and Quality of Life) Questionnaire.

MATERIALS AND METHODS

54 patients with symptomatic uterine fibroids were enrolled in this prospective study. The patients completed the UFS-QOL Questionnaire prior to MRgFUS treatment as well as after 3, 6, and 12 months.

RESULTS

The rate of technical success was 91.5 % (95.2 % after subtraction of screening errors). 6/54 patients (11 %) had other treatments (surgery, n = 4; UAE, n = 2), 8/54 (15 %) dropped out due to pregnancy, and 8/54 were lost to follow-up. The remaining group showed considerable symptom relief as early as after 3 months. The median overall quality of life score increased from 64.7 (quartile range QR: 49.8 - 77.6) before treatment to 77.6 (QR: 61.4 - 87.1) (p < 0.001), 78.4 (QR: 66.4 - 89.7) (p < 0.001), and 82.8 (QR: 69.8 - 92.2) (p < 0.001) at 3, 6, and 12 months, respectively. The corresponding median symptom severity score decreased from 46.9 (QR: 28.1 - 56.2) to 34.4 (QR: 21.9 - 43.7) at 3 months (p = 0.003) and 28.1 at 6 and 12 months (QR: 18.7 - 38.3, QR: 15.6 - 34.4) (p < 0.001, p = 0.002). The rate of complications requiring treatment was 9 %, and the rate of overall complications was 39 %. No major complications occurred.

CONCLUSION

Our results indicate significant alleviation of fibroid-related symptoms within 12 months of MRgFUS with improvement beginning as early as 3 months after treatment. We observed no major complications, and some women became pregnant after MRgFUS. There was a low treatment failure rate of 11 %.

摘要

目的

使用经过验证的美国子宫肌瘤症状与生活质量(USF-QOL)问卷,研究磁共振引导聚焦超声手术(MRgFUS)治疗绝经前有症状子宫肌瘤的临床疗效。

材料与方法

54例有症状子宫肌瘤患者纳入本前瞻性研究。患者在MRgFUS治疗前以及治疗后3、6和12个月完成UFS-QOL问卷。

结果

技术成功率为91.5%(扣除筛查误差后为95.2%)。6/54例患者(11%)接受了其他治疗(手术,4例;子宫动脉栓塞术,2例),8/54例(15%)因怀孕退出,8/54例失访。其余组早在3个月后就显示出症状明显缓解。总体生活质量评分中位数从治疗前的64.7(四分位间距QR:49.8 - 77.6)分别提高到治疗后3个月的77.6(QR:61.4 - 87.1)(p < 0.001)、6个月的78.4(QR:66.4 - 89.7)(p < 0.001)和12个月的82.8(QR:69.8 - 92.2)(p < 0.001)。相应的症状严重程度评分中位数从46.9(QR:28.1 - 56.2)在3个月时降至34.4(QR:21.9 - 43.7)(p = 0.003),在6个月和12个月时降至28.1(QR:18.7 - 38.3,QR:15.6 - 34.4)(p < 0.001,p = 0.002)。需要治疗的并发症发生率为9%,总体并发症发生率为39%。未发生重大并发症。

结论

我们的结果表明,MRgFUS治疗12个月内子宫肌瘤相关症状明显减轻,早在治疗后3个月就开始改善。我们未观察到重大并发症,且一些女性在MRgFUS治疗后怀孕。治疗失败率低,为11%。

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