Department of Obstetrics and Gynecology, University of Tennessee Health Science Center, Memphis, TN, 38163, USA.
Johns Hopkins School of Medicine, Baltimore, MD, 21205, USA.
Reprod Sci. 2023 May;30(5):1495-1505. doi: 10.1007/s43032-022-01120-9. Epub 2022 Nov 18.
Improvement in symptom severity and quality of life (QoL) are critical concerns for women with fibroids as they evaluate treatment options. This systematic review analyzed available evidence regarding minimally invasive approaches to fibroid treatment and compared validated QoL and fibroid-associated symptom scores before and after treatment. A comprehensive search was conducted using PubMed, Embase, Cochrane Library, and Scopus from January 1990 to July 2020. English-language publications were included if they evaluated associations between minimally invasive approaches to fibroid treatment and QoL or fibroid-associated symptoms, and they used validated questionnaires before and after treatment. QoL or fibroid-associated symptom scores were compared and summarized for each minimally invasive approach. Thirty-seven studies were ultimately included in this review: 26 evaluating individual approaches and 11 which were comparative studies of minimally invasive approaches and surgical interventions. Radiofrequency ablation (RFA) and ultrasound-guided sclerotherapy (USGS) significantly improved overall QoL. Uterine artery embolization (UAE) and ultrasound-guided high-intensity frequency ultrasound (US-HIFU) improved overall QoL to a similar extent as surgical interventions. Twenty-eight studies assessed fibroid-associated symptoms with the Uterine Fibroid Symptoms Quality of Life Questionnaire (UFS-QoL). UAE, magnetic resonance imaging-guided high-intensity frequency ultrasound (MR-HIFU), US-HIFU, RFA, and percutaneous microwave ablation (PMWA) significantly decreased Symptom Severity Score by a range of 21 to 39 points (out of 100) at 6 months. Minimally invasive approaches to treat fibroids were effective alternatives to surgical interventions for improving quality of life, fibroid-associated symptoms, and pain. Outcomes among minimally invasive approaches were similar, presenting patients with numerous options for fibroid treatment.
改善症状严重程度和生活质量（QoL）是子宫肌瘤女性评估治疗选择的关键关注点。本系统评价分析了子宫肌瘤微创治疗方法的现有证据，并比较了治疗前后经过验证的 QoL 和与肌瘤相关的症状评分。使用 PubMed、Embase、Cochrane Library 和 Scopus 从 1990 年 1 月到 2020 年 7 月进行了全面搜索。如果英语出版物评估了子宫肌瘤微创治疗方法与 QoL 或与肌瘤相关的症状之间的关联，并且在治疗前后使用了经过验证的问卷，则将其纳入本研究。比较并总结了每种微创方法的 QoL 或与肌瘤相关的症状评分。最终纳入了 37 项研究：26 项评估单一方法，11 项为微创方法与手术干预的比较研究。射频消融（RFA）和超声引导下硬化疗法（USGS）显著改善了整体 QoL。子宫动脉栓塞术（UAE）和超声引导高强度聚焦超声（US-HIFU）改善整体 QoL 的程度与手术干预相似。28 项研究使用子宫肌瘤症状生活质量问卷（UFS-QoL）评估了与肌瘤相关的症状。UAE、磁共振成像引导高强度聚焦超声（MR-HIFU）、US-HIFU、RFA 和经皮微波消融（PMWA）在 6 个月时使症状严重程度评分降低了 21 至 39 分（满分 100 分）。微创方法治疗子宫肌瘤是替代手术干预以改善生活质量、与肌瘤相关的症状和疼痛的有效方法。微创方法的结果相似，为患者提供了多种子宫肌瘤治疗选择。
