症状性子宫肌瘤磁共振引导高强度聚焦超声（MR-HIFU）治疗期间围手术期治疗中断的发生率及危险因素——一项回顾性病例对照研究

Occurrence and Risk Factors for Perioperative Treatment Discontinuation during Magnetic Resonance-Guided High-Intensity Focused Ultrasound (MR-HIFU) Therapy in Symptomatic Uterine Fibroids-A Retrospective Case-Control Study.

作者信息

Kociuba Jakub, Łoziński Tomasz, Latra Kamil, Korczyńska Lidia, Skowyra Artur, Zarychta Elżbieta, Ciebiera Michał

机构信息

Second Department of Obstetrics and Gynecology, Center of Postgraduate Medical Education, 00-189 Warsaw, Poland.

Warsaw Institute of Women's Health, 00-189 Warsaw, Poland.

出版信息

J Clin Med. 2023 Sep 16;12(18):5999. doi: 10.3390/jcm12185999.

DOI:10.3390/jcm12185999

PMID:37762939

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC10531787/

Abstract

BACKGROUND

The main aim of our study involves the analysis of reasons and risk factors for perioperative treatment discontinuation in patients with symptomatic uterine fibroids (UFs) who were qualified for magnetic resonance-guided high-intensity focused ultrasound (MR-HIFU) and in whom the procedure was discontinued.

METHODS

The presented research included 372 women who were primarily eligible for MR-HIFU, but the procedure was interrupted. The reasons and risk factors for treatment discontinuation were analyzed. A statistical comparison of two cohorts (patients in whom the treatment was discontinued and completed) was conducted based on epidemiological factors, UF characteristics and the implementation of uterotonics.

RESULTS

The mean discontinuation rate was 18.28% ( = 68). The main reason was the malposition of the intestines (52.94% of all cases). The thermoablation of subserosal UFs was a statistically significant risk factor of perioperative treatment discontinuation (OR 4.62, CI 95% 2.04-10.56), while the therapy of intramural UFs considerably decreased the risk (OR 0.21, CI 95% 0.08-0.51). The volume of the targeted UF was negatively correlated with the risk of discontinuation (OR 0.991, CI 95% 0.986-0.996). Augmentation with oxytocin, but not misoprostol, during the procedure significantly decreased the risk of potential discontinuation (OR 0.15, CI 95% 0.045-0.387, < 0.001).

CONCLUSION

Although the discontinuation rate seems to be relatively low, further prospective randomized trials are needed to confirm our results. The establishment of particular eligibility criteria for the treatment is a crucial issue in this area. Resigning from the procedure in cases at a high risk of discontinuation might increase patient safety and shorten the time to introduce the most appropriate therapy.

摘要

背景

我们研究的主要目的是分析符合磁共振引导下高强度聚焦超声（MR-HIFU）治疗条件但手术中断的有症状子宫肌瘤（UFs）患者围手术期治疗中断的原因和风险因素。

方法

本研究纳入了372名最初符合MR-HIFU治疗条件但手术中断的女性。分析了治疗中断的原因和风险因素。基于流行病学因素、UF特征和宫缩剂的使用情况，对两个队列（治疗中断和完成治疗的患者）进行了统计学比较。

结果

平均中断率为18.28%（n = 68）。主要原因是肠道位置不当（占所有病例的52.94%）。浆膜下UFs的热消融是围手术期治疗中断的一个统计学显著风险因素（OR 4.62，95%CI 2.04 - 10.56），而肌壁间UFs的治疗则显著降低了风险（OR 0.21，95%CI 0.08 - 0.51）。目标UF的体积与中断风险呈负相关（OR 0.991，95%CI 0.986 - 0.996）。术中使用缩宫素而非米索前列醇显著降低了潜在中断的风险（OR 0.15，95%CI 0.045 - 0.387，P < 0.001）。