经皮影像引导下的前腹壁子宫内膜异位症瘢痕的冷冻消融治疗。

Percutaneous Imaging-guided Cryoablation of Endometriosis Scars of the Anterior Abdominal Wall.

机构信息

Gynecology Unit, CMCO (Drs. Jouffrieau, Gabriele, Faller, Host, and Garbin).

Department of Interventional Radiology (Drs. Cazzato, Weiss, Garnon, and Gangi), University Hospital of Strasbourg, Strasbourg, France.

出版信息

J Minim Invasive Gynecol. 2023 Nov;30(11):890-896. doi: 10.1016/j.jmig.2023.06.018. Epub 2023 Jul 6.

DOI:10.1016/j.jmig.2023.06.018

PMID:37422051

Abstract

STUDY OBJECTIVE

To evaluate the safety and clinical efficacy of percutaneous imaging-guided cryoablation for the management of anterior abdominal wall endometriosis.

DESIGN

Patients with abdominal wall endometriosis underwent percutaneous imaging-guided cryoablation and had a 6-month follow-up.

SETTING

Data dealing with patients' and anterior abdominal wall endometriosis (AAWE) characteristics, cryoablation, and clinical and radiologic outcomes were retrospectively collected and analyzed.

PATIENTS

Twenty-nine consecutive patients underwent cryoablation from June 2020 to September 2022.

INTERVENTIONS

Interventions were performed under US/computed tomography (CT) guidance or magnetic resonance imaging (MRI) guidance. Cryoprobes were directly inserted into the AAWE, and cryoablation was performed with a single 5 to 10 minute freezing cycle, which was stopped when the iceball expanded 3 to 5 mm beyond AAWE borders as assessed on intra-procedural cross-sectional imaging.

MEASUREMENTS AND MAIN RESULTS

Fifteen patients (15/29; 51.7%) had prior endometriosis, 28 (28/29; 95.5%) had previous cesarian section, and 22 (22/29; 75.9%) referred association between symptoms and menses. Cryoablation was performed under local (16/29; 55.2%) or general anesthesia (13/29; 44.8%) and mainly in an out-patient basis (18/20; 62%). There was only one (1/29; 3.5%) minor procedure-related complication. Complete symptom relief was recorded in 62.1% (18/29) and 72.4% (21/29) patients at 1 and 6 months, respectively. In the whole population, pain significantly dropped at 6 months compared to the baseline (1.1 ± 2.3; range 0-8 vs 7.1 ± 1.9; range 3-10; p <.05). Eight (8/29; 27.6%) patients presented residual symptoms at 6 months, and 4 (4/29; 13.8%) had an MRI-confirmed residual/recurring disease. Contrast-enhanced MRI obtained for the first 14 (14/29; 48.3%) patients of the series, all without signs of residual/recurring disease, demonstrated a significantly smaller ablation area compared to the baseline volume of the AAWE (1.0 cm ± 1.4; range 0-4.7; vs 11.1 ± 9.9 cm; range 0.6-36.4; p <.05).

CONCLUSION

Percutaneous imaging-guided cryoablation of AAWE is safe and clinically effective in achieving pain relief.

摘要

研究目的

评估经皮影像引导冷冻消融术治疗前腹壁子宫内膜异位症的安全性和临床疗效。

设计

对腹壁子宫内膜异位症患者进行经皮影像引导冷冻消融术，并进行 6 个月随访。

地点

回顾性收集并分析了患者和前腹壁子宫内膜异位症（AAWE）特征、冷冻消融术以及临床和影像学结果的数据。

患者

2020 年 6 月至 2022 年 9 月，连续 29 例患者接受冷冻消融术。

干预措施

在超声/计算机断层扫描（CT）或磁共振成像（MRI）引导下进行干预。将冷冻探针直接插入 AAWE，在单次 5 至 10 分钟的冷冻周期中进行冷冻消融，当术中横断面成像评估冰球扩大至 AAWE 边界外 3 至 5 毫米时停止冷冻消融。

测量和主要结果

15 例患者（15/29；51.7%）有子宫内膜异位症病史，28 例（28/29；95.5%）有剖宫产史，22 例（22/29；75.9%）有症状与月经的关联。冷冻消融术在局部麻醉（16/29；55.2%）或全身麻醉（13/29；44.8%）下进行，主要在门诊进行（18/20；62.1%）。只有 1 例（1/29；3.5%）轻微的与手术相关的并发症。在 1 个月和 6 个月时，分别有 62.1%（18/29）和 72.4%（21/29）的患者完全缓解症状。在整个人群中，与基线相比，6 个月时疼痛明显减轻（1.1±2.3；范围 0-8 与 7.1±1.9；范围 3-10；p<.05）。8 例（8/29；27.6%）患者在 6 个月时仍有残留症状，4 例（4/29；13.8%）患者经 MRI 证实有残留/复发性疾病。对前 14 例（14/29；48.3%）患者进行的对比增强 MRI 检查均无残留/复发性疾病的迹象，与 AAWE 的基线体积相比，消融区明显缩小（1.0cm±1.4；范围 0-4.7；与 11.1cm±9.9；范围 0.6-36.4；p<.05）。