Zhang Qing, Liang Xiaowen, Chen Zhiyi
Key Laboratory of Medical Imaging Precision Theranostics and Radiation Protection, College of Hunan Province, the Affiliated Changsha Central Hospital, Hengyang Medical School, University of South China, Changsha, People's Republic of China.
Institute of Medical Imaging, Hengyang Medical School, University of South China, Hengyang, People's Republic of China.
Int J Womens Health. 2024 Sep 23;16:1551-1563. doi: 10.2147/IJWH.S473005. eCollection 2024.
There is a growing trend towards minimally invasive or noninvasive alternatives for gynecological disorders due to their rapid alleviation of symptom, expedited recovery, and minimal risks of postoperative complications. Thermal ablation technology has been commonly advocated as a minimally invasive therapeutic methods in recent years, including microwave ablation, radiofrequency ablation, and high-intensity focused ultrasound. The increasing application scenarios require updated and systematic research, and more evidence to promote their appropriate use. The objective of this review is to summarize the latest views of ablation from a prospective of fertility protection, endeavor to clarify the clinical value of thermal ablation technology in protecting fertility by assessing parameters such as ablation rates, alleviation of disease symptoms, re-intervention rates and post-treatment pregnancy rates. We review the clinical studies of ablation for uterine fibroids and adenomyosis treatment in the past 10 years, summarize the limitation and the prospects of its development in the treatment process, so as to provide clinicians with advice on the best practice. In the management of uterine fibroids and adenomyosis, thermal ablation technology offers improved fertility preservation and minimizes normal tissue injury compared to traditional surgical approaches for patients pursuing reproductive goals. In the future, thermal ablation technology will play a significantly enhanced role in preserving fertility for individuals requiring treatment for uterine fibroids and adenomyosis, guided by indications. But further research is still needed in the form of more extensive randomized prospective trials to provide stronger evidence supporting this perspective.
由于能够快速缓解症状、加速康复且术后并发症风险极小，针对妇科疾病的微创或无创替代疗法的趋势日益增长。近年来，热消融技术一直被普遍倡导为一种微创治疗方法，包括微波消融、射频消融和高强度聚焦超声。应用场景的不断增加需要更新和系统的研究，以及更多证据来促进其合理使用。本综述的目的是从生育保护的角度总结消融的最新观点，通过评估消融率、疾病症状缓解情况、再次干预率和治疗后妊娠率等参数，努力阐明热消融技术在保护生育方面的临床价值。我们回顾了过去10年中用于治疗子宫肌瘤和子宫腺肌病的消融临床研究，总结了其在治疗过程中的局限性和发展前景，以便为临床医生提供最佳实践建议。在子宫肌瘤和子宫腺肌病的管理中，与传统手术方法相比，热消融技术为追求生殖目标的患者提供了更好的生育保护，并最大限度地减少了正常组织损伤。未来，在适应证的指导下，热消融技术将在为需要治疗子宫肌瘤和子宫腺肌病的个体保留生育能力方面发挥显著增强的作用。但仍需要以更广泛的随机前瞻性试验的形式进行进一步研究，以提供支持这一观点的更强有力证据。
