超声引导高强度聚焦超声治疗子宫后壁肿块前行预处理肠道准备。

Pretreatment bowel manipulation during ultrasound-guided high-intensity focused ultrasound therapy for posterior wall uterine masses.

机构信息

Department of Obstetrics and Gynecology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Department of Obstetrics and Gynecology, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Department of Obstetrics and Gynecology, Kuo General Hospital, Tainan, Taiwan.

Department of Gynecology, Xiangya Hospital of Central South University, Changsha, Hunan, China.

出版信息

Taiwan J Obstet Gynecol. 2021 Nov;60(6):1078-1083. doi: 10.1016/j.tjog.2021.09.020.

DOI:10.1016/j.tjog.2021.09.020

PMID:34794741

Abstract

OBJECTIVE

High-intensity focused ultrasound (HIFU) therapy is a noninvasive alternative to conventional abdominal surgery in obstetrics and gynecology. The aim of this study is to evaluate the reduction of pain intensity with bowel manipulation before ultrasound-guided HIFU treatment in women with posterior wall uterine fibroids and/or adenomyosis.

MATERIALS AND METHODS

This is a multicenter retrospective observational study. Data from all patients who underwent HIFU therapy at three HIFU clinics (Sichuan Maternal and Child Health Hospital, Xiangya Hospital of Central South University, and Kuo General Hospital) between January 2019 and December 2019 were analyzed. We compared pain intensity with and without bowel manipulation during the HIFU treatment and evaluated tolerability without intravenous sedation. The presence of discomfort or pain during the HIFU procedure was evaluated using the visual analog scale (VAS).

RESULTS

A total of 86 women were included in this study. All women underwent HIFU therapy with the PRO-2008 system in the supine position for posterior wall uterine fibroids and/or adenomyosis. Thirty-seven women received pretreatment anal catheterization with a condom and 49 women were not subjected to bowel manipulation. All patients received pretreatment condom-catheter device were well tolerated during the procedure of bowel manipulation. During the HIFU procedure, the women who had received bowel manipulation experienced lower pain intensity, especially less sacrococcygeal pain (VAS score 1.56 ± 1.46 vs 2.89 ± 1.61), target region pain (1.54 ± 1.30 vs 2.53 ± 1.29), and radiating pain (0.13 ± 0.34 vs 0.41 ± 0.54), compared with the women without bowel manipulation.

CONCLUSION

Bowel manipulation with anal catheterization before HIFU therapy for posterior wall uterine masses can be safely performed and is effective as a low risk intervention to aid in reducing potential HIFU complications related to nerve involvement.

摘要

目的

高强度聚焦超声（HIFU）治疗是妇产科传统腹部手术的一种非侵入性替代方法。本研究旨在评估在经阴道超声引导 HIFU 治疗后壁子宫肌瘤和/或腺肌症患者时，肠道操作对减轻疼痛强度的影响。

材料与方法

这是一项多中心回顾性观察性研究。分析了 2019 年 1 月至 12 月期间在 3 家 HIFU 诊所（四川妇幼保健院、中南大学湘雅医院和郭综合医院）接受 HIFU 治疗的所有患者的数据。我们比较了 HIFU 治疗过程中有无肠道操作时的疼痛强度，并评估了无静脉镇静时的耐受性。使用视觉模拟评分（VAS）评估 HIFU 过程中不适或疼痛的存在。

结果

本研究共纳入 86 名女性。所有女性均采用 PRO-2008 系统在仰卧位下接受后壁子宫肌瘤和/或腺肌症的 HIFU 治疗。37 名女性接受了预处理肛门插管带避孕套，49 名女性未进行肠道操作。所有接受预处理避孕套-导管装置的患者在肠道操作过程中均耐受良好。在 HIFU 过程中，接受肠道操作的女性疼痛强度较低，尤其是尾骨疼痛（VAS 评分 1.56±1.46 比 2.89±1.61）、靶区疼痛（1.54±1.30 比 2.53±1.29）和放射痛（0.13±0.34 比 0.41±0.54）。