Yu Liang, Zhu Shu, Zhang Huiyuan, Wang Anqi, Sun Guodong, Liang JiaLe, Wang Xiuli
Nanjing Medical University, Nanjing, China.
Department of Gynecology, Jiangsu Province Hospital, Nanjing, China.
Int J Hyperthermia. 2021;38(1):1126-1132. doi: 10.1080/02656736.2021.1954245.
High-intensity focused ultrasound (HIFU) is a promising and non-invasive therapy for symptomatic uterine fibroids. Currently, the main image-guided methods for HIFU include magnetic resonance-guided (MR-HIFU) and ultrasound-guided (US-HIFU). However, there are few comparative studies on the therapeutic efficacy and safety of MR-HIFU and US-HIFU in treating symptomatic uterine fibroids with a volume <300 cm.
We performed this meta-analysis to evaluate the efficacy and safety of MR-HIFU and US-HIFU in treating symptomatic uterine fibroids with a volume <300 cm.
We searched relevant literature in PubMed, EMBASE, Cochrane Library CNKI from inception until 2021. The mean value, the proportion, and their 95% confidence intervals (CIs) were measured by random-effects models. Publication bias was assessed using funnel plots.
48 studies met our inclusion criteria-28 describing MR-HIFU and 20 describing US-HIFU. The mean non-perfused volume rate (NPVR) was 81.07% in the US-HIFU group and 58.92% in the MR-HIFU group, respectively. The mean volume reduction rates at month-3, month-6, and month-12 were 42.42, 58.72, and 65.55% in the US-HIFU group, while 34.79, 37.39, and 36.44% in the MR-HIFU group. The incidence of post-operative abdominal pain and abnormal vaginal discharge in the US-HIFU group was lower than that of MRI-HIFU. However, post-operative skin burn and sciatic nerve pain were more common in the US-HIFU group compared with MRI-HIFU. The one-year reintervention rate after MR-HIFU was 13.4%, which was higher than 5.2% in the US-HIFU group.
US-HIFU may show better efficiency and safety than MR-HIFU in treating symptomatic fibroids with a volume <300 cm.
高强度聚焦超声（HIFU）是一种有前景的、用于治疗有症状子宫肌瘤的非侵入性疗法。目前，HIFU主要的图像引导方法包括磁共振引导（MR-HIFU）和超声引导（US-HIFU）。然而，关于MR-HIFU和US-HIFU治疗体积<300 cm³有症状子宫肌瘤的疗效和安全性的比较研究较少。
我们进行这项荟萃分析以评估MR-HIFU和US-HIFU治疗体积<300 cm³有症状子宫肌瘤的疗效和安全性。
我们检索了自数据库建立至2021年期间PubMed、EMBASE、Cochrane图书馆及中国知网（CNKI）中的相关文献。采用随机效应模型测量均值、比例及其95%置信区间（CI）。使用漏斗图评估发表偏倚。
48项研究符合我们的纳入标准，其中28项描述MR-HIFU，20项描述US-HIFU。US-HIFU组的平均无灌注体积率（NPVR）分别为81.07%，MR-HIFU组为58.92%。US-HIFU组在第3个月、第6个月和第12个月的平均体积缩小率分别为42.42%、58.72%和65.55%，而MR-HIFU组分别为34.79%、37.39%和36.44%。US-HIFU组术后腹痛和异常阴道分泌物的发生率低于MR-HIFU组。然而，与MR-HIFU相比，US-HIFU组术后皮肤烧伤和坐骨神经痛更常见。MR-HIFU术后一年的再次干预率为13.4%，高于US-HIFU组的5.2%。
在治疗体积<300 cm³有症状子宫肌瘤方面，US-HIFU可能比MR-HIFU显示出更好的疗效和安全性。
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