Department of Obstetrics and Gynecology, The Affifiliated Hospital of North Sichuan Medical College, Nanchong, China.
Int J Hyperthermia. 2021;38(1):183-188. doi: 10.1080/02656736.2021.1874546.
To compare the efficacy and safety of high-intensity focused ultrasound (HIFU) and gonadotropin-releasing analogues (GnRH-a) as pretreatments for the hysteroscopic transcervical resection of myoma (TCRM) for type 2 submucosal fibroids greater than 4 centimeters in diameter.
Seventy-nine patients were assigned into two groups according patient preference: 42 in HIFU and 37 in GnRHa. TCRM was performed after 3 months of pretreatment with HIFU or GnRHa.
Following pretreatment with HIFU or GnRHa, uterine-fibroid symptom (UFS) scores and hemoglobin levels (HGB) showed improvement. The fibroid maximum diameter, size of fibroids, and volume of the uterus were decreased. Following HIFU pretreatment, one case reported complete vaginal fibroid expulsion, and four reported partial fibroid expulsion. No similar cases were found in the GnRHa group. Eighteen patients were lost to follow-up prior to TCRM. Among the 31 patients in HIFU, the fibroids were downgraded to type 0 in 10 cases and type 1 in 5 cases. Of the 30 patients in GnRHa, the treated fibroids were downgraded to type 1 in 9 cases. The mean operation time and intraoperative blood loss of the HIFU group were significantly lower than those in the GnRHa group. No significant differences were observed in the incidence of intraoperative complications and the one-time resection rate of fibroids between the two groups (>.05).
HIFU seems to be superior to GnRHa as a pretreatment method prior to TCRM for type 2 submucosal fibroids greater than 4 centimeters in diameter.
比较高强度聚焦超声（HIFU）和促性腺激素释放类似物（GnRH-a）预处理对直径大于 4 厘米的 2 型黏膜下肌瘤行宫腔镜经宫颈肌瘤切除术（TCRM）的疗效和安全性。
根据患者意愿，将 79 例患者分为 HIFU 组（42 例）和 GnRHa 组（37 例）。HIFU 或 GnRHa 预处理 3 个月后行 TCRM。
HIFU 或 GnRHa 预处理后，子宫纤维瘤症状（UFS）评分和血红蛋白（HGB）水平均有所改善。肌瘤最大直径、肌瘤大小和子宫体积均减小。HIFU 预处理后，1 例报告完全阴道肌瘤排出，4 例报告部分肌瘤排出。GnRHa 组未发现类似病例。18 例患者在 TCRM 前失访。在 31 例 HIFU 患者中，10 例肌瘤降为 0 型，5 例降为 1 型。GnRHa 组的 30 例患者中，9 例治疗后的肌瘤降为 1 型。HIFU 组的手术时间和术中出血量明显低于 GnRHa 组。两组术中并发症发生率和肌瘤一次性切除率无显著差异（>.05）。
HIFU 似乎优于 GnRHa，可作为直径大于 4 厘米的 2 型黏膜下肌瘤行 TCRM 前的预处理方法。
