| Objectives:To make the statistical analysis of the clinical effects of ultrasound-guided percutaneous microwave ablation of uterine leiomyoma(UPMWA),and to explore the advantages of ultrasound-guided percutaneous microwave ablation of uterine leiomyoma by comparing the perioperative effects of laparoscopic myomectomy(LM)and abdominal myomectomy(AM).Materials and methods:The clinical data of patients with uterine leiomyoma treated in our hospital from January2018 to February 2020 were divided into microwave ablation group(n=48),laparoscopy group(n=44)and laparotomy group(n=50).The volume and reduction rate of the largest myoma before and 1,3,6 and 12 months after operation in the microwave ablation group were calculated.The ultrasound images of each period,the changes of contrast-enhanced ultrasound(CEUS)and magnetic resonance imaging(MRI)before and 1 month after operation were observed,and the improvements of clinical symptoms 12 months after operation were calculated.The size of skin incision,the Intraoperative bleeding volume,the decrease of hemoglobin at the first day after operation,the length of operation,the time of first anal exhaust,the times of dressing change,pain relief,fever,total hospital stay and postoperative hospital stay were compared among the three groups.Results:1.The reductions of uterine leiomyoma by microwave ablation In the microwave ablation group,the volume of maximum myoma before operation was 187.22±46.65cm~3,and the volume of maximum myoma at 1-month,3-months,6-months and 12-months after operation of follow-up were 95.20±57.03cm~3,58.06±38.68cm~3,42.16±29.30cm~3and 28.20±19.04cm~3,respectively.The reduction rate of the volume of maximum myoma at 1-month,3-months,6-months and 12-months after operation of follow-up were 43.88±18.90%,65.42±18.59%,74.47±16.56%and 82.39±12.99%,respectively.2.The imaging changes of uterine leiomyoma by microwave ablation Before the microwave ablation,all leiomyomas were shown to be the hypoechoic nodules or the moderate echoic nodules by the two-dimensional gray-scale ulrtasound,had dot or strip blood flow signals by the ultrasonic color doppler flow imaging(CDFI),and had enhancement by CEUS and MRI.After the microwave ablation,all leiomyomas were shown to be the heterogeneous echoic nodules by the two-dimensional gray-scale ulrtasound,had no blood flow signal by the ultrasonic CDFI,and had no enhancement by CEUS and MRI at 1-month after operation.3.The improvements of clinical symptoms of uterine leiomyoma by microwave ablation In the 12 months after the operation,menstrual symptoms were improved in 25 cases(25/28),anemia symptoms improved in 8 cases(8/8),lower abdominal discomfort improved in 11 cases(11/13),and urinary compression symptoms improved in 5 cases(5/5).4.The comparisons of perioperative effects of three surgical procedures The overall distribution of skin incision size in microwave ablation group was 0.25(0.20,0.30)cm,which was smaller than that in the laparoscopy group(3.00(3.00,3.50)cm)and the laparotomy group(8.00(8.00,8.00)cm)significantly,and both differences were statistically significant(both Adj.P<0.001).The overall distribution of intraoperative blood loss in the microwave ablation group was 5.00(2.00,5.00)ml,which was less than that in the laparoscopy group(20.00(10.00,50.00)ml)and the laparotomy group(50.00(27.50,100.00)ml)significantly,and both differences were statistically significant(both Adj.P<0.001).One day after operation,the average decrease of hemoglobin in the microwave ablation group was 9.69±7.26g/L,which was lower than that in the laparoscopy group(19.23±10.84g/L)and the laparotomy group(16.01±11.60g/L)significantly,and both differences were statistically significant(all P<0.001).The average operation time in microwave ablation group was 109.46±39.64min,which was longer than that in the laparotomy group(71.54±20.80min),and the difference between the microwave ablation group and the laparotomy group was statistically significant(P<0.001),but there was no significant difference between the microwave ablation group and the laparoscopic group(121.20±35.81min)(P>0.05).The overall distribution of the times of postoperative dressing changes in the microwave ablation group was 0(0,0)times,which was less than that in the laparoscopy group(2.00(2.00,2.00)times)and the laparotomy group(2.00(2.00,2.00)times),and both differences were statistically significant(both Adj.P<0.001).The average total length of stay in the microwave ablation group was 6.63±2.15 days,which was less than that in the laparoscopy group(7.57±1.37 days)and the laparotomy group(8.72±1.53 days),and both differences were statistically significant(both P<0.001).The overall distribution of postoperative hospitalization days in the microwave ablation group was 4.00(3.00,5.00)days,which was less than that in the laparotomy group(6.00(5.00,6.00)days),and the difference between the microwave ablation group and the laparotomy group was statistically significant(Adj.P<0.001),but there was no significant difference between the microwave ablation group and the laparoscopy group(4.00(4.00,5.00)days)(Adj.P>0.05).The rate of the first time of the anal exsufflation within 24 hours after operation in the microwave ablation group was 100%,which was greater than that in the laparoscopy group(34.1%)and the laparotomy group(20.0%),and both differences were statistically significant(both P<0.05).There was no significant difference in postoperative fever and pain relief among the three groups(both P>0.05).Conclusions:Ultrasound-guided percutaneous microwave ablation is effective in the treatment of uterine leiomyoma,which is less invasive,less bleeding and faster recovery than laparoscopic myomectomy and abdominal myomectomy. |
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