局部麻醉下超声引导经皮冷冻消融术：一种有前景的症状性子宫腺肌病治疗方法。

Ultrasound-guided percutaneous cryoablation under local anesthesia: a promising treatment method for symptomatic adenomyosis.

作者信息

Qi Yue, Wang Xinyue, Qi Xinyu, Li Zhixun, Huang Ying

机构信息

Department of Ultrasound, Shengjing Hospital of China Medical University, Shenyang, China.

出版信息

Quant Imaging Med Surg. 2025 Aug 1;15(8):7382-7391. doi: 10.21037/qims-24-2159. Epub 2025 Jul 25.

DOI:10.21037/qims-24-2159

PMID:40785870

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC12332589/

Abstract

BACKGROUND

Adenomyosis is characterized by ectopic endometrial tissue, which causes dysmenorrhea, menstruation, and infertility, significantly impairing quality of life. Current treatments-including medications, surgery, and interventional methods-all have limitations. Cryoablation, a technique that induces tissue necrosis through ultra-low temperature exposure followed by rapid thawing, has demonstrated efficacy in treating solid tumors (e.g., liver and kidney cancer). However, its application in adenomyosis remains in the exploratory phase. This study aims to evaluate the feasibility and efficacy of ultrasound (US)-guided percutaneous cryoablation for adenomyosis.

METHODS

A retrospective study was conducted on symptomatic adenomyosis patients seeking uterine and fertility preservation who underwent US-guided percutaneous cryoablation at the Shengjing Hospital of China Medical University from January 2024 to September 2024. Follow-up assessments were conducted at 1, 3, and 6 months postoperatively. Dysmenorrhea severity was evaluated using the Visual Analogue Scale (VAS). The quality of life was quantified using the Uterine Fibroid Symptom and Quality of Life Questionnaire (UFS-QOL) score. Treatment efficacy was assessed based on changes in uterine volume and lesion volume measured by US. Intraoperative and postoperative complications were recorded to evaluate safety.

RESULTS

A total of 8 patients with adenomyosis underwent cryoablation under local anesthesia. The median VAS score was 8.5 [interquartile range (IQR), 7.75-9] postoperatively, 5.5 (IQR, 4.75-6; P<0.05) at 1 month, 4 (IQR, 4-4; P<0.05) at 3 months, and 3 (IQR, 2.75-3.25; P<0.05) at 6 months. Six months postoperatively, the median UFS-QOL score decreased from 132 (IQR, 121.5-138) preoperatively to 93 (IQR, 87.5-98, P<0.05). US revealed a 68% uterine volume reduction from 334.89 cm (IQR, 259.22-410.52 cm) to 106.49 cm (IQR, 72.91-185.16 cm, P<0.05). Adenomyosis lesion volume decreased from 134.93 cm (IQR, 122.94-196.07 cm) to 20.58 cm (IQR, 19.60-69.61 cm, P<0.05). No intraoperative complications were reported. Within 2 hours postoperatively, 5 out of 8 patients (62.5%) reported abdominal pain, but all pain resolved on the same day.

CONCLUSIONS

US-guided percutaneous cryoablation under local anesthesia is safe and effective in the short-term follow-up for treating adenomyosis, offering a promising uterine-sparing alternative for symptomatic patients.

摘要

背景

子宫腺肌病以异位子宫内膜组织为特征，可导致痛经、月经异常和不孕，严重影响生活质量。目前的治疗方法，包括药物治疗、手术治疗和介入治疗，都有局限性。冷冻消融是一种通过超低温暴露诱导组织坏死，随后快速解冻的技术，已在实体肿瘤（如肝癌和肾癌）治疗中显示出疗效。然而，其在子宫腺肌病中的应用仍处于探索阶段。本研究旨在评估超声（US）引导下经皮冷冻消融治疗子宫腺肌病的可行性和疗效。

方法

对2024年1月至2024年9月在中国医科大学附属盛京医院接受US引导下经皮冷冻消融治疗、有症状且希望保留子宫和生育功能的子宫腺肌病患者进行回顾性研究。术后1、3和6个月进行随访评估。使用视觉模拟量表（VAS）评估痛经严重程度。使用子宫肌瘤症状与生活质量问卷（UFS-QOL）评分量化生活质量。根据超声测量的子宫体积和病灶体积变化评估治疗效果。记录术中及术后并发症以评估安全性。

结果

共有8例子宫腺肌病患者在局部麻醉下接受了冷冻消融治疗。术后VAS评分中位数为8.5[四分位间距（IQR），7.75 - 9]，1个月时为5.5（IQR，4.75 - 6；P<0.05），3个月时为4（IQR，4 - 4；P<0.05），6个月时为3（IQR，2.75 - 3.25；P<0.05）。术后6个月，UFS-QOL评分中位数从术前的132（IQR，121.5 - 138）降至93（IQR，87.5 - 98，P<0.05）。超声显示子宫体积从334.89 cm（IQR，259.22 - 410.52 cm）减少了68%，降至106.49 cm（IQR，72.91 - 185.16 cm，P<0.05）。子宫腺肌病病灶体积从134.93 cm（IQR，122.94 - 196.07 cm）降至20.58 cm（IQR，19.60 - 69.61 cm，P<0.05）。未报告术中并发症。术后2小时内，8例患者中有5例（62.5%）报告腹痛，但所有疼痛均在当天缓解。