| ObjectiveTo investigate the safety and the short-term treatment efficiency of ultrasound-guided percutaneous microwave ablation(MWA)for uterine fibroids(UFs)and analyze the factors that affectthesufficientablationof UFsin MWA.Toprovidereliableevidencesupportforthefeasibility of MWA treatment of UFs and predict theshort-term efficacy of patients receiving this treatment.MethodsFrom July 2020 to November 2022,a total of 46 patients with 85 UFs who had undergone ultrasound-guided MWA in Shanghai Tenth People Hospital were retrospectively included in this study.To evaluate the safety of MWA according to the incidence of adverse events(AEs).The efficacyof MWAwasassessedat1-,3-,6-,and12monthfollow-upsafter MWAtreatment,andthe assessmentincludedvolumereductionratios(VRR)of UFs,uterinevolumereduction,quantitative hemoglobin(Hb),uterine fibroid symptom(UFS)and quality of life(Qo L)scores,and clinical symptoms.Then,pre-treatment clinical characteristics,conventional ultrasound,and contrast-enhanced ultrasound(CEUS)features were analyzed to explore their correlation with volume reduction ratios(VRR)of sufficient ablation(i.e.a VRR of at least 50% at the 3-month follow-up).Results1.The procedures of percutaneous MWA for UFs were tolerated well and no major complications related to the MWA occurred in all patients.Mild adverse events after treatment included fever(26.1%,12/46)pain(30.4%,14/46),nausea and vomiting(15.2%,7/46),and vaginal discharge(76.1%,35/46),all of which werecured after symptomatictreatment.2.At the 1-,3-,6-,and 12-month follow-up,the median VRRs of UFs were32.0%,46.2%,46.8%,and 70.1% respectively.the median VRRs for uterine volume was 14.1%,26.8%,29.4%,and 36.9% respectively.Compared with before treatment,the volume of the uterus and uterine fibroids were significantly smaller(P < 0.05).In addition,the relevant clinical symptomsofallpatientswerealleviatedorremoved.82.9%(29/35)patientshadsignificantreliefof symptoms of lower abdominal discomfort,71.4%(5/7)patients had shortened menstrual period,and 63.6%(7/11)patients had normal menstrual cycles.60.0%(12/20)had reduced menstrual volume,and 62.5%(10/16)had reduced or disappeared menstrual blood clots.50.0%(3/6)of the patients had relief or disappearance of abnormal leukorrhea,75.0%(18/24)had relief of dysmenorrhea,and64.3%(9/14)hadreliefordisappearanceofanemia.After MWA,the UFSscore and Qo L score decreased significantly in comparison with those before MWA(all P <0.05),The median UFS score decreased from 17.0(11.0,20.0)to 11.0(8.8,15.5)(P < 0.05),and the median Qo L score decreased from 65.5(43.0,77.0)to 53.0(40.3,67.8)(P < 0.05).Hb values were higher thanbefore,100.0(88.0,110.0)g/Lbefortreatment and112.5g(95.5,125.9)g/Laftertreatment(P=0.023).The total effective rates were 55.3%,70.4%,90.6%,and 95.2% at 1,3,6,and 12 months after treatment,respectively.3.At the 3-month follow-up,46.3%(25/54)of fibroids obtained sufficient ablation while the remaining53.7%(29/54)obtainedpartialablation(i.e.a VRRof<50%).Non-enhancingareainthe lesion during the early phase(i.e.within 30 s after injecting contrast agent)on pre-treatment CEUS waspresentin 27.8% UFs,which was associated with sufficientablation atthe3-month follow-up(P<0.05).Age,courseofthedisease,BMI,volumeandlocationofuterine,number,location,type,blood supply,echo properties,volume and the maximum diameter of UFs,NPVR,enhanced homogeneity,enhancementmargin,earlyhyperenhancement,andcoarseortwistpenetratingvessel of CEUS characteristics were not correlated with sufficient ablation(all P > 0.05).Conclusion1.Ultrasound-guided MWA isa safeand effective method to treat patients with UFs.2.Non-enhancing area during the early phase on pretreatment CEUS is significantly associatedwithsufficientablation3 monthsafter MWAtreatmentof UFs(P<0.05),whichmightbe used to predict short-treatment outcome.Figure [7] Table[8] Reference[60]... |
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