Feasibility, safety and efficacy of high intensity focused ultrasound ablation as a preoperative treatment for challenging hysteroscopic myomectomy

作者全名：He, Yuchun; Wu, Min; Guo, Xu; Ran, Feng; Li, Haiyan; Zhang, Daibi; Wang, Yaqin; Zeng, Jin; Chen, Xuelian; Zhai, Linghui; Li, Xiaohui; Lei, Tingting

作者地址：[He, Yuchun; Wu, Min; Li, Haiyan; Zhang, Daibi; Wang, Yaqin; Zeng, Jin; Zhai, Linghui; Li, Xiaohui; Lei, Tingting] Suining Municipal Hosp Tradit Chinese Med, Dept Gynecol & Obstet, Suining, Peoples R China; [Guo, Xu; Chen, Xuelian] Suining Municipal Hosp Tradit Chinese Med, Dept Oncol, Suining, Peoples R China; [Ran, Feng; Lei, Tingting] Chongqing Med Univ, State Key Lab Ultrasound Med & Engn, Chongqing 400016, Peoples R China

通信作者：Lei, TT (通讯作者)，Chongqing Med Univ, State Key Lab Ultrasound Med & Engn, Chongqing 400016, Peoples R China.

来源：INTERNATIONAL JOURNAL OF HYPERTHERMIA

ESI学科分类：CLINICAL MEDICINE

WOS号：WOS:001248523300001

JCR分区：Q2

影响因子：3

年份：2024

卷号：41

期号：1

开始页：　

结束页：　

文献类型：Article

关键词：High intensity focused ultrasound ablation; hysteroscopic myomectomy; uterine fibroids; pretreatment; downgrade

摘要：Purpose: To investigate the feasibility, safety and efficacy of high intensity focused ultrasound ablation (HIFU) as a preoperative treatment for challenging hysteroscopic myomectomies. Materials and methods: 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). Results: 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. Conclusion: 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.

基金机构：Foundation of State Key Laboratory of Ultrasound in Medicine and Engineering [2021KFKT012]; Scientific Research Projects of Sichuan Maternal and Child Health Association [21FX018]

基金资助正文：This study was supported by the Foundation of State Key Laboratory of Ultrasound in Medicine and Engineering (Grant No. 2021KFKT012) and the Scientific Research Projects of Sichuan Maternal and Child Health Association (Grant No. 21FX018).