| Background:Uterine fibroids are the most common benign gynaecological tumors in premenopausal women.Women with clinical symptoms such as menorrhagia,pelvic pain or pressure and infertility need treatment.Myomectomy is one of the primary surgical treatments that can achieve symptomatic relief and preserve reproductive functions at the same time.However,the risk of recurrence is a concern and abdomino-pelvic adhesions adds to the difficulties of reoperation.High-intensity focused ultrasound(HIFU)ablation,a noninvasive tissue ablation technique,has been recognized for its safety and satisfactory therapeutic efficacy in symptomatic uterine fibroids.Previous reports have shown that HIFU and myomectomy were similarly efficacious in short-term.In addition,HIFU was associated with fewer adverse effects and complications than myomectomy.To the best of our knowledge,long-term results of up to 5 years of observation comparing these two procedures have not been published to date.Besides,the pregnancy outcomes and complications during perinatal period among patients with desire for future fertility of observation comparing these two procedures have not been reported.Objectives:1.To compare the long-term outcomes after HIFU versus myomectomy for uterine fibroids.2.To compare the long-term outcomes after HIFU versus secondary myomectomy for women with symptomatic recurrent uterine fibroids following myomectomy.3.To compare the pregnancy outcomes and complications during perinatal period after HIFU versus myomectomy for women with desire for future fertility.Methods:1.A retrospective study was conducted on 763 women who were treated by HIFU and 1205 women who underwent myomectomy for uterine fibroids at the Chinese People’s Liberation Army General Hospital from January 2007 to January 2015.Regular follow-up was conducted to evaluate the symptoms relief,symptoms recurrence,the need for additional interventions and compilications of the two groups.2.A retrospective study was conducted on 101 women who were treated by HIFU and 87 women who underwent secondary myomectomy for symptomatic recurrent uterine fibroids following myomectomy at the Chinese People’s Liberation Army General Hospital from January 2007 to December 2016.Regular follow-up was conducted to evaluate the symptoms relief,symptoms recurrence,the need for additional interventions and compilications of the two groups.3.A retrospective study was conducted on 174 women who were treated by HIFU and 349 women with desire for future fertility who underwent myomectomy for uterine fibroids at the Chinese People’s Liberation Army General Hospital from January 2007 to January 2015.Regular follow-up was conducted to evaluate the fertility outcomes,including pregnancy rate,conception methods,delivery modes,neonatal outcomes and complications during perinatal period of the two groups.Results:1.The successful and persistent symptoms relief rates were 95.7%and 84.1%in women who were treated by HIFU.Similarly,the rates were 95.5%and 85.1%in women who underwent myomectomy.No statistical differences were seen between the two groups,however,the decrease in transformed symptom severity scale(tSSS)was significantly better after HIFU than after myomectomy.The cumulative rates of symptoms recurrence at 1 year,3 years,5 years,8 years and 10 years of follow-up in HIFU group were 1.8%,6.8%,11.9%,15.2%and 15.9%,respectively.And the cumulative re-intervention rates were 0.7%,4.1%,6.8%,9.9%and 11.0%,respectively.The cumulative rates of symptoms recurrence at 1 year,3years,5 years,8 years and 10 years of follow-up in myomectomy group were 1.8%,5.9%,10.6%,14.2%and 14.9%,respectively.And the cumulative re-intervention rates were 0.9%,4.5%,7.8%,10.3%and 11.4%,respectively.No statistical differences were seen between the two groups.The incidence of adverse events was lower in HIFU group than myomectomy group.2.The successful and persistent symptoms relief rates were 94.1%and 78.9%in women with symptomatic recurrent uterine fibroids who were treated by HIFU.Similarly,the rates were 96.6%and 73.8%in women who underwent secondary myomectomy.No statistical differences were seen between the two groups,however,the decrease in tSSS was significantly better after HIFU than after secondary myomectomy.The cumulative rates of symptoms recurrence at 1 year,3 years,5 years and 8 years of follow-up in HIFU group were 0%,7.4%,16.8%and 21.1%,respectively.And the cumulative re-intervention rates were 0%,3.2%,9.5%and 13.7%,respectively.The cumulative rates of symptoms recurrence at 1 year,3 years,5 years and 8 years of follow-up in secondary myomectomy group were 4.8%,16.7%,26.2%and 26.2%,respectively.And the cumulative re-intervention rates were 4.8%,11.9%,15.5%and 17.9%,respectively.The cumulative rates of symptoms recurrence and re-intervention were lower in HIFU group at 1 year and 3 years of follow-up,but no statistical differences were seen at 5 years and 8 years of follow-up between the two groups.The incidence of adverse events was lower in the HIFU group than secondary myomectomy group.3.A total of 92 pregnancies in 83 women occurred in HIFU group,and the pregnancy rate was 47.7%.239 pregnancies in 197 women occurred in myomectomy group,and the pregnancy rate was 56.4%.No statistical difference was seen between the two groups.The median interval between myomectomy and pregnancy was 33 months(range,3-100 months).The median interval between HIFU and pregnancy was 17 months(range,1-66 months),which was shorter than myomentomy.The nature pregnancy rate was 94.6%,artificial insemination rate was 5.4%in HIFU group and 77(83.7%)of the pregnancies resulted in deliveries,9(9.8%)ended in miscarriages,5(5.4%)ended in elective termination and 1(1.1%)pregnancy was ongoing.The nature pregnancy rate was 89.5%,artificial insemination rate was 10.5%in myomectomy group and 185(77.4%)of the pregnancies resulted in deliveries,23(9.6%)ended in miscarriages,24(10%)ended in elective termination and 7(3.0%)pregnancies were ongoing.No statistical differences were seen between the two groups of pregnancy results.The vaginal delivery rate was 28.6%in HIFU group,which was higher than that of myomectomy(16.2%).Cesarean sections were occurred in 71.4%of women in HIFU group,which was lower than that of myomectomy(83.8%).No statistical differences were seen between the two groups of neonate outcomes and pregnancy complications.Conclusions:1.Satisfaction with long-term outcomes after HIFU ablation treatment or myomectomy for uterine fibroids was comparable.HIFU ablation treatment seems to be safer with less adverse events than myomectomy.2.For women with symptomatic recurrent uterine fibroids following myomectomy,the interval of persistent symptoms relief was longer and adverse events rate was lower in HIFU ablation treatment than secondary myomectomy.3.For women with desire for future fertility,the interval between HIFU ablation treatment was shoter and cesarean sections rate was lower than myomectomy. |
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