Li Fang, Chen Jing, Yin Li, Zeng Dingyuan, Wang Li, Tao Hua, Wu Xiajuan, Wei Feng, Xu Fan, Shi Qiuling, Lin Zhong, Wang Zhibiao
State Key Laboratory of Ultrasound in Medicine and Engineering, College of Biomedical Engineering, Chongqing Medical University, Chongqing, China.
Liuzhou Maternity and Child Healthcare Hospital, Affiliated Women and Children's Hospital of Guangxi University of Science and Technology, Liuzhou, China.
Int J Hyperthermia. 2023;40(1):2155077. doi: 10.1080/02656736.2022.2155077.
To compare pregnancy outcomes after high-intensity focused ultrasound ablation (HIFU), myomectomy and uterine artery embolization (UAE) for fertility-sparing patients with uterine fibroids and to investigate the possible mechanism of improving pregnancy by HIFU.
A meta-analysis of 54 studies containing 12,367 patients was conducted to compare the pregnancy outcomes of three fertility-sparing therapies. And a retrospective self-control study of 26 patients with uterine fibroids from May 2019 to December 2020 was performed to assess the blood flow impedance of bilateral uterine arteries before and after HIFU.
In the analysis by treatment option, the pregnancy rate after myomectomy was 0.43 (95% CI 0.36-0.49), which was higher than 0.18 (95% CI 0.10-0.26) after HIFU, the latter was significantly higher than that after UAE (ratio 0.08, 95% CI 0.06-0.10). The miscarriage rate after HIFU was 0.08 (95% CI 0.04-0.12), which was similar to 0.15 (95% CI 0.09-0.21) after myomectomy and also similar to 0.16 after UAE (95% CI 0.01-0.30). In the subgroup analysis, women who received ultrasound guided HIFU (USgHIFU) were more likely to have ideal pregnancy outcomes than that after magnetic resonance imaging-guided HIFU. The pulsatility index and resistance index on the right side were significantly higher 3 months after HIFU than before (1.637 ± 0.435 vs. 1.845 ± 0.469; = 0.033; 0.729 ± 0.141 vs. 0.784 ± 0.081, = 0.039).
HIFU, especially USgHIFU, may be an alternative fertility-sparing modality for patients with uterine fibroids over 40 years old. HIFU may contribute to improving pregnancy rates by elevating uterine blood flow impedance.
比较高强度聚焦超声消融（HIFU）、子宫肌瘤剔除术和子宫动脉栓塞术（UAE）对有保留生育功能需求的子宫肌瘤患者的妊娠结局，并探讨HIFU改善妊娠的可能机制。
对54项研究（共12367例患者）进行荟萃分析，以比较三种保留生育功能治疗方法的妊娠结局。对2019年5月至2020年12月的26例子宫肌瘤患者进行回顾性自身对照研究，以评估HIFU治疗前后双侧子宫动脉的血流阻抗。
在按治疗方法的分析中，子宫肌瘤剔除术后的妊娠率为0.43（95%CI 0.36 - 0.49），高于HIFU后的0.18（95%CI 0.10 - 0.26），后者显著高于UAE后的妊娠率（比值0.08，95%CI 0.06 - 0.10）。HIFU后的流产率为0.08（95%CI 0.04 - 0.12），与子宫肌瘤剔除术后的0.15（95%CI 0.09 - 0.21）相似，也与UAE后的0.16（95%CI 0.01 - 0.30）相似。在亚组分析中，接受超声引导HIFU（USgHIFU）的女性比接受磁共振成像引导HIFU的女性更有可能获得理想的妊娠结局。HIFU后3个月右侧的搏动指数和阻力指数显著高于治疗前（1.637±0.435对1.845±0.469；P = 0.033；0.729±0.141对0.784±0.081，P = 0.039）。
HIFU，尤其是USgHIFU，可能是40岁以上子宫肌瘤患者保留生育功能的一种替代方式。HIFU可能通过提高子宫血流阻抗有助于提高妊娠率。
