Liu Yue, Huang Jing, Du Chengchao, Jiang Jing, Zhou Honggui, Qu Dacheng
Department of Obstetrics and Gynecology, Affiliated Hospital of North Sichuan Medical College, Nanchong, China.
Non-invasive and Microinvasive Laboratory of Gynecology, Affiliated Hospital of North Sichuan Medical College, Nanchong, China.
Int J Hyperthermia. 2023;40(1):2192448. doi: 10.1080/02656736.2023.2192448.
Due to resistance and intolerance to chemotherapy, localized lesion resection may be required in some patients with Gestational trophoblastic neoplasia (GTN), which may lead to massive bleeding. In this case report, we describe the successful use of high-intensity focused ultrasound (HIFU) as an effective pretreatment method for surgical procedure in a patient with GTN to reduce the perioperative risk and the impact on fertility.
A 26-year-old woman was diagnosed with high-risk GTN (FIGO Stage III: 12 prognostic scores) after a hydatidiform mole. The fifth chemotherapy cycle was interrupted due to severe chemotherapy toxicity. However, the uterine lesion was still present and the beta-human chorionic gonadotropin (β-hCG) level was not restored to normal. Therefore, ultrasound-guided HIFU was performed as a pretreatment method to shrink the lesion and prevent massive bleeding during localized lesion resection. The effectiveness of ablation was evaluated immediately using contrast-enhanced ultrasound and Color Flow Doppler ultrasonography. One month after HIFU treatment, the uterine lesion was completely resected under hysteroscopic surgery. During the surgery, HIFU was found to have shrunk the lesion and there was minimal bleeding (5 mL). The uterine cavity morphology and menstruation returned to normal after surgery. The patient has showed no signs of recurrence as of one-year follow-up.
Ultrasound-guided HIFU ablation may be a new choice for high-risk GTN patients with chemoresistance or chemo-intolerance. As a noninvasive pretreatment method, HIFU can shrink the uterine lesion, and reduce the risk of bleeding with no obvious effect on fertility.
由于对化疗产生耐药性和不耐受性，部分妊娠滋养细胞肿瘤（GTN）患者可能需要进行局部病灶切除术，这可能导致大量出血。在本病例报告中，我们描述了成功使用高强度聚焦超声（HIFU）作为一名GTN患者手术的有效预处理方法，以降低围手术期风险和对生育能力的影响。
一名26岁女性在葡萄胎后被诊断为高危GTN（FIGO分期III期：预后评分12分）。由于严重的化疗毒性，第五个化疗周期中断。然而，子宫病灶仍然存在，β-人绒毛膜促性腺激素（β-hCG）水平未恢复正常。因此，进行了超声引导下的HIFU作为预处理方法，以缩小病灶并防止局部病灶切除术中的大量出血。立即使用超声造影和彩色多普勒超声评估消融效果。HIFU治疗1个月后，在宫腔镜手术下完全切除子宫病灶。手术中发现HIFU使病灶缩小，出血极少（5毫升）。术后子宫腔形态和月经恢复正常。截至一年随访，患者未显示复发迹象。
超声引导下的HIFU消融可能是对化疗耐药或不耐受的高危GTN患者的一种新选择。作为一种非侵入性预处理方法，HIFU可以缩小子宫病灶，并降低出血风险，对生育能力无明显影响。
