Department of Radiology, Isala Hospital, Dokter van Heesweg 2, 8025 AB, Zwolle, The Netherlands.
Department of Gynecology, Isala, Zwolle, The Netherlands.
Eur Radiol. 2020 Jul;30(7):3869-3878. doi: 10.1007/s00330-020-06780-2. Epub 2020 Mar 12.
The clinical applicability of magnetic resonance image-guided high-intensity focused ultrasound (MR-HIFU) treatment of uterine fibroids is often limited due to inaccessible fibroids or bowel interference. The aim of this study was to implement a newly developed 3-step modified manipulation protocol and to evaluate its influence on the number of eligible women and treatment failure rate.
From June 2016 to June 2018, 165 women underwent a screening MRI examination, 67 women of whom were consecutively treated with MR-HIFU at our institution. Group 1 (n = 20) was treated with the BRB manipulation protocol which consisted of sequential applications of urinary bladder filling, rectal filling, and urinary bladder emptying. Group 2 (n = 47) was treated using the 3-step modified manipulation protocol which included (1) the BRB maneuver with adjusted rectal filling by adding psyllium fibers to the solution; (2) Trendelenburg position combined with bowel massage; (3) the manual uterine manipulation (MUM) method for uterine repositioning. A comparison was made between the two manipulation protocols to evaluate differences in safety, the eligibility percentage, and treatment failure rate due to unsuccessful manipulation.
After implementing the 3-step modified manipulation protocol, our ineligibility rate due to bowel interference or inaccessible fibroids decreased from 18% (16/88) to 0% (0/77). Our treatment failure rate due to unsuccessful manipulation decreased from 20% (4/20) to 2% (1/47). There were no thermal complications to the bowel or uterus.
Implementation of the 3-step modified manipulation protocol during MR-HIFU therapy of uterine fibroids improved the eligibility percentage and reduced the treatment failure rate.
Registry number NL56182.075.16 KEY POINTS: • A newly developed 3-step modified manipulation protocol was successfully implemented without the occurrence of thermal complication to the bowel or uterus. • The 3-step modified manipulation protocol increased our eligibility percentage for MR-HIFU treatment of uterine fibroids. • The 3-step modified manipulation protocol reduced our treatment failure rate for MR-HIFU treatment of uterine fibroids.
由于子宫肌瘤位置不佳或肠道干扰，磁共振引导高强度聚焦超声（MR-HIFU）治疗的临床适用性往往受到限制。本研究旨在实施一种新开发的三步改良操作方案，并评估其对符合条件的女性数量和治疗失败率的影响。
2016 年 6 月至 2018 年 6 月，165 名女性接受了筛查性 MRI 检查，其中 67 名女性连续在我院接受了 MR-HIFU 治疗。第 1 组（n=20）接受了 BRB 操作方案的治疗，该方案包括连续进行膀胱充盈、直肠充盈和膀胱排空。第 2 组（n=47）采用三步改良操作方案治疗，包括（1）BRB 操作，通过向溶液中添加车前子纤维来调整直肠充盈；（2）使用肠道按摩的特伦德伦堡体位；（3）手动子宫复位（MUM）方法。比较两种操作方案在安全性、符合率和因操作失败导致的治疗失败率方面的差异。
实施三步改良操作方案后，由于肠道干扰或子宫肌瘤位置不佳导致的不合格率从 18%（16/88）降至 0%（0/77）。由于操作失败导致的治疗失败率从 20%（4/20）降至 2%（1/47）。未发生肠道或子宫热并发症。
在子宫肌瘤的 MR-HIFU 治疗中实施三步改良操作方案可提高符合率并降低治疗失败率。
注册号 NL56182.075.16。
成功实施了一种新开发的三步改良操作方案，未发生肠道或子宫热并发症。
三步改良操作方案提高了子宫肌瘤 MR-HIFU 治疗的符合率。
三步改良操作方案降低了子宫肌瘤 MR-HIFU 治疗的治疗失败率。
