Department of Gynecology and Obstetrics, Suining Municipal Hospital of Traditional Chinese Medicine, Suining, China.
Department of Oncology, Suining Municipal Hospital of Traditional Chinese Medicine, Suining, China.
Int J Hyperthermia. 2024;41(1):2365974. doi: 10.1080/02656736.2024.2365974. Epub 2024 Jun 16.
To investigate the feasibility, safety and efficacy of high intensity focused ultrasound ablation (HIFU) as a preoperative treatment for challenging hysteroscopic myomectomies.
A total of 75 patients diagnosed with types 0-III of uterine fibroids were enrolled. Based on the Size, Topography, Extension of the base, Penetration and lateral Wall position (STEPW) classification scoring system, 25 cases with a score ≥ 5 points were treated with HIFU followed by hysteroscopic myomectomy (HIFU + HM group), whereas 50 cases with a score < 5 points were treated with hysteroscopic myomectomy (HM group).
The median preoperative STEPW score was 7 in the HIFU + HM group and 2 in the HM group. The average non-perfused volume (NPV) ratio achieved in fibroids after HIFU was 86.87%. Patients in the HIFU + HM group underwent hysteroscopic myomectomy one to four days after HIFU, and downgrading was observed in 81.81% of fibroids. The operation time for patients in the HIFU + HM group was 73 min and the success rate of myomectomy in a single attempt was 60%. The volume of distention medium used during the operation was greater in the HIFU + HM group than in the HM group (15,500 ml vs. 7500 ml). No significant difference was observed between the two groups in terms of intraoperative blood loss, the incidence of intraoperative and postoperative complications, menstrual volume score, or uterine fibroid quality of life score.
HIFU can be utilized as a preoperative treatment for large submucosal fibroids prior to hysteroscopic myomectomy. HIFU offers a novel approach in the management of this subset of patients.
探讨高强度聚焦超声消融（HIFU）作为有挑战性的宫腔镜子宫肌瘤切除术术前治疗的可行性、安全性和疗效。
共纳入 75 例诊断为 0-III 型子宫肌瘤的患者。根据大小、地形、基底部扩展、穿透和侧壁位置（STEPW）分类评分系统，25 例评分≥5 分的患者接受 HIFU 联合宫腔镜子宫肌瘤切除术（HIFU+HM 组）治疗，50 例评分<5 分的患者接受宫腔镜子宫肌瘤切除术（HM 组）治疗。
HIFU+HM 组术前 STEPW 评分中位数为 7 分，HM 组为 2 分。HIFU 后肌瘤的平均非灌注体积（NPV）比值为 86.87%。HIFU+HM 组患者在 HIFU 后 1-4 天行宫腔镜子宫肌瘤切除术，81.81%的肌瘤出现降级。HIFU+HM 组患者的手术时间为 73 分钟，单次尝试子宫肌瘤切除术的成功率为 60%。HIFU+HM 组术中使用的扩张介质体积大于 HM 组（15500ml 比 7500ml）。两组术中出血量、术中及术后并发症发生率、月经血量评分或子宫肌瘤生活质量评分无显著差异。
HIFU 可作为宫腔镜子宫肌瘤切除术术前治疗大型黏膜下肌瘤的方法。HIFU 为这部分患者的治疗提供了一种新方法。
