Endometriosis Section, Gynecologic Division, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, São Paulo, Brazil (Drs. Marques, Andres, and Abrão).
Endometriosis Section, Gynecologic Division, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, São Paulo, Brazil (Drs. Marques, Andres, and Abrão); Gynecologic Division, BP-A Beneficência Portuguesa de São Paulo, São Paulo, São Paulo, Brazil (Drs. Andres and Abrão).
J Minim Invasive Gynecol. 2020 Feb;27(2):332-343. doi: 10.1016/j.jmig.2019.07.029. Epub 2019 Aug 1.
To systematically review the literature regarding the efficacy of high-intensity focused ultrasound (HIFU) in reducing adenomyotic lesions, patients' pain and bleeding symptoms, and the impact on patients' quality of life.
A search was performed through PubMed/MEDLINE and Cochrane databases.
All available studies published in the English language in the last 10 years that evaluated the effects of HIFU for adenomyosis.
TABULATION, INTEGRATION, AND RESULTS: A systematic review was performed following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. A meta-analysis was performed on data from homogeneous studies. Pooled results from the meta-analysis showed that after HIFU treatment for adenomyosis, a large effect was observed in reducing the uterine volume at 12 months (standard mean difference [SMD] = 0.85), a significant reduction in dysmenorrhea at 3 months (SMD = 1.83) and 12 months (SMD = 2.37), and a significant improvement in quality of life at 6 months (SMD = 3.0) and 12 months (SMD = 2.75). Adverse reactions after HIFU were reported in 55.9% of patients.
This review suggests a potential benefit for HIFU in the treatment of adenomyosis-related symptoms; however, findings of the meta-analysis were based on fewer, nonuniform studies, which did not equally account for each specific symptom/parameter across the board. Results showed there appears to be a potential of HIFU in the treatment of adenomyosis-related symptoms. To date, there are no comparative and randomized clinical trials comparing the HIFU technique with other conservative treatment options. As yet, there are insufficient data regarding fertility and pregnancy outcomes.
系统回顾高强度聚焦超声（HIFU）治疗子宫腺肌病的疗效、患者疼痛和出血症状以及对患者生活质量的影响的文献。
通过 PubMed/MEDLINE 和 Cochrane 数据库进行检索。
检索所有在过去 10 年内发表的、评估 HIFU 治疗子宫腺肌病的疗效的可用英语文献。
列表、整合和结果：按照系统评价和荟萃分析的首选报告项目指南进行系统评价。对同质研究的数据进行荟萃分析。荟萃分析的汇总结果显示，HIFU 治疗子宫腺肌病后 12 个月时子宫体积明显缩小（标准均数差[SMD] = 0.85），3 个月和 12 个月时痛经明显减轻（SMD = 1.83 和 SMD = 2.37），6 个月和 12 个月时生活质量明显改善（SMD = 3.0 和 SMD = 2.75）。HIFU 后有 55.9%的患者出现不良反应。
本综述表明 HIFU 治疗子宫腺肌病相关症状可能具有一定的益处；然而，荟萃分析的结果基于较少的、非统一的研究，这些研究并没有全面平等地考虑每个特定的症状/参数。结果表明，HIFU 可能在治疗子宫腺肌病相关症状方面具有一定的潜力。迄今为止，尚无比较 HIFU 技术与其他保守治疗方法的对照随机临床试验。关于生育和妊娠结局的资料仍然不足。
