Jeng Cherng-Jye, Ou Kae-Ying, Long Cheng-Yu, Chuang Linus, Ker Chin-Ru
Department of Obstetrics and Gynecology, Kaohsiung Medical University Hospital, Kaohsiung City, Taiwan; Department of Obstetrics and Gynecology, Graduate School of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.
Department of Obstetrics and Gynecology, Kaohsiung Medical University Hospital, Kaohsiung City, Taiwan.
Taiwan J Obstet Gynecol. 2020 Nov;59(6):865-871. doi: 10.1016/j.tjog.2020.09.013.
Clinical outcomes of 500 high-intensity focused ultrasound (HIFU)-treated uterine fibroids and adenomyosis are analyzed and presented.
This is a retrospective cross-sectional analysis from a single tertiary medical center. From April 2015 to October 2018, 546 cases were enrolled for the study. After excluding 46 patients with less than 3 months of follow-up period, there were 404 fibroids, 149 adenomyosis and 53 mixed conditions entered for analysis. The patients' uterine fibroids and adenomyosis were treated by HIFU according to Chongqing Haifu protocol, with 12 cm diameter transducer of focal length 10-16 cm at 0.8 or 1.6 MHz T2-weight MRI imaging was rendered prior to and 3 month post treatment to assess lesion volume change using non-perfusion volume, which was the primary outcome. Secondary outcomes including quality of life, subjective satisfaction, adverse events and pregnancy rate were determined using self-reported questionnaires. The mean follow up period ranged from 3 to 38 months with an average of 21 months.
Three months after HIFU-treated uterine fibroids and adenomyosis, the lesion size reduced 40.2% and 46.3%, respectively. Symptoms all improved with better quality of life for the fibroid group, while those with adenomyosis or combined diseases benefit the most from pain control. Serum CA125 decreased significantly for all studied groups, and LDH only showed improvement for fibroids group. Number of adverse events is comparable to Chongqing data (approximately 10.2%), with mostly mild and self-resolving conditions. No permanent sequelae or death was documented. Twelve pregnancies are reported in this cohort.
HIFU is safe and effective in treating uterine fibroids and adenomyosis. The results are reproducible if standardized treatment schedules are followed. It is a promising treatment alternative with the advantages of precision, non-invasiveness, rapid recovery and readiness for pregnancy.
分析并呈现500例经高强度聚焦超声（HIFU）治疗的子宫肌瘤和子宫腺肌病的临床结局。
这是一项来自单一三级医疗中心的回顾性横断面分析。2015年4月至2018年10月，共有546例患者纳入研究。排除46例随访期不足3个月的患者后，有404例子宫肌瘤、149例子宫腺肌病和53例混合病症进入分析。根据重庆海扶方案，采用HIFU治疗患者的子宫肌瘤和子宫腺肌病，使用焦距为10 - 16 cm、直径为12 cm的换能器，频率为0.8或1.6 MHz。治疗前及治疗后3个月进行T2加权MRI成像，以使用无灌注体积评估病变体积变化，这是主要结局。次要结局包括生活质量、主观满意度、不良事件和妊娠率，通过自我报告问卷确定。平均随访期为3至38个月，平均为21个月。
HIFU治疗子宫肌瘤和子宫腺肌病3个月后，病变大小分别缩小了40.2%和46.3%。症状均有所改善，肌瘤组生活质量更好，而子宫腺肌病或合并疾病患者从疼痛控制中获益最大。所有研究组的血清CA125均显著下降，仅肌瘤组的乳酸脱氢酶有所改善。不良事件数量与重庆的数据相当（约10.2%），大多为轻度且可自行缓解的情况。未记录到永久性后遗症或死亡病例。该队列中有12例妊娠报告。
HIFU治疗子宫肌瘤和子宫腺肌病安全有效。如果遵循标准化治疗方案，结果具有可重复性。它是一种有前景的治疗选择，具有精准、无创、恢复快和利于妊娠的优点。
