Chongqing Haifu Hospital, Chongqing, China.
State Key Laboratory of Ultrasound in Medicine and Engineering, College of Biomedical Engineering, Chongqing Medical University, Chongqing, China.
Int J Hyperthermia. 2023;40(1):2249275. doi: 10.1080/02656736.2023.2249275.
To evaluate the timing and safety of hysteroscopic myomectomy for large submucosal fibroids pretreated with high intensity focused ultrasound (HIFU).
From June 2011 to December 2020, 74 patients with solitary submucousal fibroid with size larger than 4 cm who received HIFU treatment followed by hysteroscopic myomectomy were enrolled.
The average age of patients was 40.2 ± 6.7 years. Among them, 1 had type 0, 18 had type I and 55 patients had type II submucosal fibroids. The mean diameter of fibroids was 5.7 ± 1.2 cm. All patients completed HIFU in one session, and the median non-perfused volume (NPV) ratio achieved in fibroids was 90.5%. Hysteroscopic myomectomy was performed in 0-1, 1-3, 3-6, and 6-12 months after HIFU. The mean shrinkage rate of fibroids post-HIFU was 68.19 ± 19.86%, 61.10 ± 16.89%, and 63.76 ± 26.68% in 1-3 months, 3-6 months and 6-12 months, respectively. All patients completed hysteroscopic myomectomy successfully, and no intrauterine adhesion after HIFU was observed. The complete resection of fibroids achieved in 69 patients in one session of the procedure. The mean operation time was 66.66 ± 31.61 min, the median blood loss was 20 ml, and the median distention medium deficit was 275 ml. No significant difference was observed in the operation time, blood loss and distention medium deficit among patients who received hysteroscopic myomectomy at different time points ( > 0.05).
HIFU can be used as a pretreatment for large submucosal fibroids before hysteroscopic myomectomy. Based on our results, hysteroscopic myomectomy could be performed at any time point, even within 1 month after HIFU.
评估高强度聚焦超声（HIFU）预处理后行宫腔镜子宫肌瘤切除术治疗大型黏膜下肌瘤的时机和安全性。
自 2011 年 6 月至 2020 年 12 月，共纳入 74 例接受 HIFU 治疗后行宫腔镜子宫肌瘤切除术的单发黏膜下肌瘤患者，肌瘤大小均大于 4cm。
患者平均年龄为 40.2±6.7 岁。其中 1 例为 0 型，18 例为 1 型，55 例为 2 型黏膜下肌瘤。肌瘤平均直径为 5.7±1.2cm。所有患者均 1 次性完成 HIFU 治疗，肌瘤的平均非灌注体积（NPV）比值达到 90.5%。HIFU 治疗后 0-1、1-3、3-6 和 6-12 个月行宫腔镜子宫肌瘤切除术。HIFU 后 1-3、3-6 和 6-12 个月，肌瘤的平均缩小率分别为 68.19%±19.86%、61.10%±16.89%和 63.76%±26.68%。所有患者均成功完成宫腔镜子宫肌瘤切除术，HIFU 后未见宫腔粘连。69 例患者 1 次手术即完全切除肌瘤。手术时间平均为 66.66±31.61min，中位出血量为 20ml，中位膨宫介质缺失量为 275ml。不同时间点行宫腔镜子宫肌瘤切除术的患者手术时间、出血量和膨宫介质缺失量差异无统计学意义（>0.05）。
HIFU 可作为宫腔镜子宫肌瘤切除术治疗大型黏膜下肌瘤的预处理方法。根据我们的结果，宫腔镜子宫肌瘤切除术可在任何时间点进行，甚至在 HIFU 后 1 个月内。
