高强度聚焦超声消融子宫肌瘤实现非灌注体积减少率（NPVR）≥80%的技术成功率：一项多中心医生经验研究。
Physician Experience in Technical Success of Achieving NPVR ≥ 80% of High-Intensity Focused Ultrasound Ablation for Uterine Fibroids: A Multicenter Study.
作者信息
Gong Xue, Zhang Xinyue, Liu Dang, Yang Chao, Zhang Rong, Xiao Zhibo, Chen Wenzhi, Chen Jinyun
机构信息
State Key Laboratory of Ultrasound in Medicine and Engineering, College of Biomedical Engineering, Chongqing Medical University, Chongqing, China.
Department of Ultrasound Medicine, Mianyang Central Hospital, Mianyang, China.
出版信息
Front Med Technol. 2022 Mar 8;3:790956. doi: 10.3389/fmedt.2021.790956. eCollection 2021.
OBJECTIVE
To evaluate the experience of the physician of the technical success in high-intensity focused ultrasound (HIFU) ablation of uterine fibroids with a nonperfused volume ratio (NPVR) of at least 80%.
METHODS
Patients from a 20-center prospective study were enrolled in this study. In this study, among the 20 clinical centers, five centers had physician with >3 years of HIFU experience, and the other 15 centers initiated HIFU therapy <3 years, were defined as the experienced group and the inexperienced group, respectively. Technical success was defined as achieving NPVR ≥ 80% of uterine fibroids with no major complications and it was defined as the successful group; otherwise, it was defined as the unsuccessful group.
RESULTS
A total of 1,352 patients were included at the age of 41.32 ± 5.08 years. The mean NPVR (87.48 ± 14.91%) was obtained in the inexperienced group (86.50 ± 15.76%) and in the experienced group (89.21 ± 13.12%), respectively. The multivariate analysis showed that the volume of uterus, location of fibroids, and physician experience were significantly correlated with technical success ( < 0.05). In the experienced group, 82.20% of uterine fibroids obtained NPVR ≥ 80%, compared with 75.32% in the inexperienced group, and the difference was significant ( = 0.003). The technical success rate of the experienced group was 82.00% which was higher than 75.20% of the inexperienced group ( = 0.004).
CONCLUSION
In technical success of achieving NPVR ≥ 80%, experience of the physician was positively correlated with technical success; NPVR and major complications for the inexperienced group were comparable to those of the experienced group from a clinical perspective; inexperienced physicians could reach NPVR ≥ 80% of sufficient ablation and were trustworthy in efficacy. Smaller uterus and fibroids of anterior wall were correlated with better technical success; experienced physicians still have better technical success when choosing patients with larger uterus, contributing to clinical decision-making and patient referral.
目的
评估在高强度聚焦超声（HIFU）消融子宫肌瘤时，技术成功率达到非灌注体积比（NPVR）至少80%的医生的经验。
方法
本研究纳入了来自一项20中心前瞻性研究的患者。在本研究中，20个临床中心里，5个中心有3年以上HIFU经验的医生，另外15个中心开展HIFU治疗不到3年，分别定义为经验丰富组和经验不足组。技术成功定义为子宫肌瘤达到NPVR≥80%且无重大并发症，达到此标准则定义为成功组；否则定义为失败组。
结果
共纳入1352例患者，年龄为41.32±5.08岁。经验不足组和经验丰富组分别获得的平均NPVR为（86.50±15.76%）和（89.21±13.12%）。多因素分析显示，子宫体积、肌瘤位置和医生经验与技术成功显著相关（<0.05）。经验丰富组中，82.20%的子宫肌瘤NPVR≥80%，经验不足组为75.32%，差异有统计学意义（=0.003）。经验丰富组的技术成功率为82.00%，高于经验不足组的75.20%（=0.004）。
结论
在实现NPVR≥80%的技术成功方面，医生经验与技术成功呈正相关；从临床角度看，经验不足组的NPVR和重大并发症与经验丰富组相当；经验不足的医生能够达到NPVR≥80%的充分消融，疗效可靠。子宫较小和前壁肌瘤与更好的技术成功相关；经验丰富的医生在选择子宫较大的患者时仍有更好的技术成功率，有助于临床决策和患者转诊。
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