[聚焦超声消融手术与子宫肌瘤切除术治疗子宫肌瘤的长期疗效比较]
[Comparison of the long-term outcomes of focused ultrasound ablation surgery for uterine fibroids and myomectomy].
作者信息
Liu X, Wang W, Tang Y, Wang Y K, Luo L, Song Lei
机构信息
Department of Ultrasound, First Medical Center of Chinese PLA General Hospital, Beijing 100853, China.
Department of Obstetrics and Gynecology, First Medical Center of Chinese PLA General Hospital, Beijing 100853, China.
出版信息
Zhonghua Fu Chan Ke Za Zhi. 2022 Apr 25;57(4):244-252. doi: 10.3760/cma.j.cn112141-20210830-00476.
To compare the long-term outcomes after focused ultrasound ablation surgery (FUAS) versus myomectomy for uterine fibroids. A retrospective study was conducted on women who were treated by FUAS or myomectomy for uterine fibroids at First Medical Center of Chinese PLA General Hospital from January 2007 to January 2015. Regular follow-up was conducted to evaluate the symptoms relief, symptoms recurrence, the need for re-interventions and complications of the two groups. The effective rates were 95.7% (730/763) and 95.5% (1 151/1 205) in women who were treated by FUAS and myomectomy, no statistical difference was seen between the two groups (²0.027, =0.869). The cumulative rates of symptoms recurrence at 1 year, 3 years, 5 years, 8 years and 10 years of follow-up in FUAS group were 1.8%, 6.8%, 11.9%, 15.2% and 15.9%, respectively; and the cumulative re-intervention rates were 0.7%, 4.1%, 6.8%, 9.9% and 11.0%, respectively. The cumulative rates of symptoms recurrence at 1 year, 3 years, 5 years, 8 years and 10 years of follow-up in myomectomy group were 1.8%, 5.9%, 10.6%, 14.2% and 14.9%, respectively; and the cumulative re-intervention rates were 0.9%, 4.5%, 7.8%, 10.3% and 11.4%, respectively. No statistical differences were seen between the two groups (all >0.05). There were no significant differences in the effective rate, symptoms recurrence rate and re-intervention rate between the two groups in patients with intermural fibroids; but the effective rate of FUAS (95.9%, 235/245) was higher than that of myomectomy (89.1%, 115/129), the symptoms recurrence rate (11.9%, 28/235) was lower than that of myomectomy (27.8%, 32/115), and the re-intervention rate (7.7%, 18/235) was lower than that of myomectomy (17.4%, 20/115) in patients with submucosal fibroids, there were significant different (all <0.05). The effective rate of FUAS (91.0%, 132/145) was lower than that of myomectomy (97.0%, 322/332), the symptoms recurrence rate (32.6%, 43/132) was higher than that of myomectomy (9.9%, 32/322), and the re-intervention rate (22.0%, 29/132) was higher than that of myomectomy group (6.2%, 20/132) in patients with subserosal fibroids, there were significant different (all <0.01). The incidences of total [1.8% (14/763) vs 21.9% (264/1 205)], minor and moderate adverse events were lower in FUAS group than myomectomy group (all <0.001). Satisfaction with long-term outcomes after FUAS treatment or myomectomy for uterine fibroids is comparable.
比较聚焦超声消融手术（FUAS）与子宫肌瘤剔除术治疗子宫肌瘤的长期疗效。对2007年1月至2015年1月在中国人民解放军总医院第一医学中心接受FUAS或子宫肌瘤剔除术治疗子宫肌瘤的女性进行回顾性研究。进行定期随访以评估两组的症状缓解情况、症状复发情况、再次干预需求及并发症。接受FUAS和子宫肌瘤剔除术治疗的女性有效率分别为95.7%（730/763）和95.5%（1151/1205），两组之间无统计学差异（²0.027，=0.869）。FUAS组在随访1年、3年、5年、8年和10年时症状复发的累积率分别为1.8%、6.8%、11.9%、15.2%和15.9%；再次干预的累积率分别为0.7%、4.1%、6.8%、9.9%和11.0%。子宫肌瘤剔除术组在随访1年、3年、5年、8年和10年时症状复发的累积率分别为1.8%、5.9%、10.6%、14.2%和14.9%；再次干预的累积率分别为0.9%、4.5%、7.8%、10.3%和11.4%。两组之间无统计学差异（均>0.05）。肌壁间肌瘤患者两组在有效率、症状复发率和再次干预率方面无显著差异；但黏膜下肌瘤患者中，FUAS的有效率（95.９%，235/245）高于子宫肌瘤剔除术（89.1%，115/129），症状复发率（11.9%，28/235）低于子宫肌瘤剔除术（27.8%，32/115），再次干预率（7.7%，18/235）低于子宫肌瘤剔除术（17.4%，20/115），差异均有统计学意义（均<0.05）。浆膜下肌瘤患者中，FUAS的有效率（91.0%，132/145）低于子宫肌瘤剔除术（97.0%，322/332），症状复发率（32.6%，43/132）高于子宫肌瘤剔除术（9.9%，32/322），再次干预率（22.0%，29/132）高于子宫肌瘤剔除术组（6.2%，20/322），差异均有统计学意义（均<0.01）。FUAS组总的[1.8%（14/763）对21.9%（264/1205）]、轻度和中度不良事件的发生率低于子宫肌瘤剔除术组（均<0.001）。FUAS治疗或子宫肌瘤剔除术治疗子宫肌瘤后的长期疗效满意度相当。
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