高强度聚焦超声消融子宫肌瘤副作用的系统评价
A systematic review of the side effects of high-intensity focused ultrasound ablation of uterine fibroids.
作者信息
Ali Mostafa Maged, Raphael Mpehle Chileshe, Olusola Esther, Ratshabedi Phuti Khomotso, Ragab Shehata Ahmed, Ashraf Youssef Mohamed, Helal Farag Ebtehal Ali
机构信息
Obstetrics and Gynecology Department, Fayoum General Hospital, Egyptian Ministry of Health and Population, Fayoum, Egypt.
High-Intensity Focused Ultrasound Unit, Department of Obstetrics and Gynaecology, Chris Hani Baragwanath Academic Hospital, Johannesburg, South Africa.
出版信息
Proc (Bayl Univ Med Cent). 2024 Aug 21;37(6):947-956. doi: 10.1080/08998280.2024.2387497. eCollection 2024.
BACKGROUND
A new intervention called high-intensity focused ultrasound (HIFU) targets fibroids with high-intensity ultrasound pulses using ultrasound probes. This noninvasive method, which can be carried out with either magnetic resonance imaging or ultrasound guidance, results in immediate coagulated necrosis within a clearly defined area a few millimeters in diameter.
METHODS
This systematic review evaluated the safety of HIFU in the treatment of uterine fibroids regardless of site or size. We specifically aimed to determine the incidence of side effects that can occur during and after HIFU. We searched the PubMed, Scopus, ScienceDirect, and Mendeley archive using only the terms HIFU and fibroid. After identifying 1077 studies of different types from 2014 to March 2024, 300 studies were screened and 60 included.
RESULTS
According to Society of Interventional Radiology guidelines, class A adverse events (AEs) showed no significant results, and individuals with these AEs required no treatment and had no long-term consequences. Similarly, there were no class B significant results. However, 3943 of 10,204 patients (38%) complained of lower abdominal pain after the procedure, a class B AE, which resolved by analgesics. Further, 153 of 24,700 patients (0.6%) had skin burns, blisters, or nodules, and these issues resolved with conservative treatment. Additionally, 74 of 23,741 patients (0.3%) had hematuria; 882 of 5970 patients (14.7%) had abnormal vaginal discharge; 414 of 23,449 (1.7%) had vaginal bleeding; and 267 of 7598 (3.5%) had leg paresthesia. Major AEs (class C and D) were almost nonexistent, and the incidence of death in our study was zero.
CONCLUSION
HIFU ablation of uterine fibroids is generally safe, causing mostly mild side effects and very few severe complications. The relative safety of HIFU compared to other minimally invasive techniques, such as uterine artery embolization, still needs further evaluation.
背景
一种名为高强度聚焦超声（HIFU）的新干预措施使用超声探头，通过高强度超声脉冲靶向子宫肌瘤。这种非侵入性方法可在磁共振成像或超声引导下进行，能在直径几毫米的明确界定区域内立即产生凝固性坏死。
方法
本系统评价评估了HIFU治疗子宫肌瘤的安全性，无论肌瘤的位置或大小如何。我们的具体目标是确定HIFU治疗期间及之后可能出现的副作用发生率。我们仅使用“HIFU”和“肌瘤”这两个术语在PubMed、Scopus、ScienceDirect和Mendeley数据库中进行检索。在识别出2014年至2024年3月期间的1077项不同类型研究后，筛选出300项研究，其中60项被纳入。
结果
根据介入放射学会指南，A级不良事件（AE）未显示出显著结果，出现这些AE的个体无需治疗且无长期后果。同样，也没有B级显著结果。然而，10204例患者中有3943例（38%）在术后抱怨下腹部疼痛，这是一种B级AE，通过使用镇痛药得以缓解。此外，24700例患者中有153例（0.6%）出现皮肤烧伤、水泡或结节，这些问题通过保守治疗得到解决。另外，23741例患者中有74例（0.3%）出现血尿；5970例患者中有882例（14.7%）出现异常阴道分泌物；23449例患者中有414例（1.7%）出现阴道出血；7598例患者中有267例（3.
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