超声引导高强度聚焦超声消融与宫腔镜子宫肌瘤切除术治疗黏膜下子宫肌瘤的比较：一项回顾性研究。

Comparison of ultrasound-guided high-intensity focused ultrasound ablation and hysteroscopic myomectomy for submucosal fibroids: a retrospective study.

机构信息

Department of Obstetrics and Gynecology, the Third Xiangya Hospital, Central South University, Changsha, PR China.

Department of Obstetrics and Gynecology, People's Hospital of Ningxiang, Changsha, PR China.

出版信息

Int J Hyperthermia. 2021;38(1):1609-1616. doi: 10.1080/02656736.2021.1995053.

DOI:10.1080/02656736.2021.1995053

PMID:34763580

Abstract

OBJECTIVE

To compare the safety, reintervention and pregnancy outcomes between ultrasound-guided high intensity focused ultrasound (USgHIFU) and hysteroscopic myomectomy (HM) for submucosal fibroids.

MATERIALS AND METHODS

A total of 215 patients with a solitary submucosal fibroid treated by USgHIFU or HM at the third Xiangya Hospital were retrospectively reviewed. Among them, 58 treated with USgHIFU, 157 treated with HM.

RESULTS

A significant difference was observed in size, location and type of the fibroids, effective rate, and cumulative reintervention rate between the two groups ( < .05). The size of the fibroids was 57.9 ± 1.9 mm in the USgHIFU group, while it was 32.6 ± 1.2 mm in the HM group. The number of the fibroids at horn or fundus/uterine cavity was 16/42 in the USgHIFU group, while it was 21/136 in the HM group. The number of type I/II/2-5 was 16/17/25 in the USgHIFU group, while it was 133/24/0 in the HM group. In the USgHIFU group, the effective rate was 100% and the cumulative reintervention rate at 50 (17-97) months was 19.0%, while in the HM group, it was 94.3% and 7.6%, respectively. During the follow-up period, the pregnancy rate was 22.4% (13/58) and the reintervention rate due to invalid and recurrence was 15.5% (9/58) in the USgHIFU group, while they were 18.5% (29/157) and 7.0% (11/157) in the HM group. No significant difference was observed between the two groups ( > .05). Furthermore, the reintervention rate was positively correlated with age, treatment methods and parity and fertility requirements. No other significant difference was observed between the two groups.

CONCLUSIONS

Both USgHIFU and HM are safe and effective in treating submucosal fibroids. Compared with the HM group, the USgHIFU group had lower postoperative complications, but higher reintervention rate, with similar recurrence rate, pregnancy rate and reintervention rate due to invalid and recurrence. Reintervention was related to age, treatment methods, parity and fertility requirements.

摘要

目的

比较超声引导高强度聚焦超声（USgHIFU）与宫腔镜子宫肌瘤切除术（HM）治疗黏膜下肌瘤的安全性、再次干预和妊娠结局。

材料和方法

回顾性分析 2018 年 1 月至 2021 年 1 月在湘雅三医院接受 USgHIFU 或 HM 治疗的 215 例单发黏膜下肌瘤患者的临床资料。其中，58 例行 USgHIFU 治疗，157 例行 HM 治疗。

结果

两组患者肌瘤大小、位置和类型、有效率和累积再次干预率比较差异有统计学意义（ < .05）。USgHIFU 组肌瘤大小为 57.9±1.9mm，HM 组为 32.6±1.2mm。USgHIFU 组肌瘤位于宫角或宫底/宫腔者 16/42 例，HM 组为 21/136 例。USgHIFU 组肌瘤类型 I/II/2-5 者分别为 16/17/25 例，HM 组为 133/24/0 例。USgHIFU 组有效率为 100%，50（17-97）个月累积再次干预率为 19.0%，HM 组分别为 94.3%和 7.6%。随访期间，USgHIFU 组妊娠率为 22.4%（13/58），因无效和复发再次干预率为 15.5%（9/58），HM 组分别为 18.5%（29/157）和 7.0%（11/157），两组比较差异均无统计学意义（ > .05）。此外，再次干预率与年龄、治疗方法和产次及生育要求呈正相关。两组间其他方面比较差异均无统计学意义。