Clinical Study On Combined High Intensity Focused Ultrasound And Radiofrequency In Treating Hypervascular Uterine Fibroids

Part One The comparative study of the efficacy of High-intensity focused ultrasound and radiofrequency treatment of uterine fibroidsObjective:Compare the efficacy of radiofrequency(RF) ablation and high-intensity focused ultrasound (HIFU) in the treatment of uterine fibroids with different blood supply and different sizes. Preliminary discussed the advantages and limitations of RF ablation and HIFU in treating uterine fibroids.Methods: From March 2008 to December 2008, one hundred patients with 138 uterine fibroids were treated with HIFU and RF respectively in Xijing hospital. The patients were divided in two groups randomly and in each group. There was no significant difference in age, the size of the fibroids and the blood supply between the two groups. All patients were divided into three subgroups by their fibroids'diameters and blood supply. These subgroups were named as ABC and A'B'C'respectively. All these patients were examined by contrast enhanced ultrasound (CEUS) one week before and after treatment. The image results were analyzed to evaluate the RF and HIFU therapeutic response. Statistical analyses were used to evaluate the efficacy of these two methods.Results: The completely ablation rate of RF was higher than that of HIFU. There had significant difference between the efficacy of RF and HIFU treatment. However, when 2.0cm?diameter<4.0cm, the difference between the efficacy of RF and HIFU had no significance. In other subgroups, the complete ablation rates of RF were better than of HIFU (p<0.05). Uterine fibroids diameters in these groups were greater than 4.0cm. In subgroup A'B'C', the study got the same results. There had no significant difference between the efficacy of RF and HIFU treatment when the fibroids'blood supply were very few. The completely ablation rate of RF was higher than that of HIFU, there was statistically difference between these two groups. But the completely ablation rate were decreased if the fibroids'blood supply became more and more abundant. No severe complications were observed after these two treatments.Conclusion: HIFU and RF are both effective in treating uterine fibroids. Both of them were very efficacy to small fibroids with few blood supplies. RF can be applied to majority of the fibroids. As a non-invasive therapy, HIFU is more suitable for small and hypovascular fibroids'treat and could be the first treating method. Part Two Study on short-term therapeutic efficacy of combined high intensity focused ultrasound and radiofrequency in treating hypervascular uterine fibroidsObjective: Combined HIFU and RF treatment in order to solve the inefficacious of HIFU treatment in treating hypervascular uterine fibroids and to raise the safety of RF treatment. Evaluate the therapeutic efficacy of this combined therapy by conventional ultrasound, color Doppler flow imaging (CDFI), CEUS and ultrasound guided needle puncture biopsy. Discuss the feasibility and effectiveness of this combined therapy.Method: From January 2009 to September 2009, 56 patients with hypervascular fibroids received combined treatment. All the patients were examined by CEUS within 1day after RF treatment. Thirty-five patients received HIFU combined RF treatment. These entire patients'fibroids'diameter was greater than 4.0cm and no more than 6.0cm. HIFU was firstly used to treat the fibroids and especially to treat the tissues closed to endometria, intestinal cannal, vagina and bladder. CEUS was used to confirm the residuals. And RF was used to treat these residuals as a compensatory treatment. Other 21 patients'hypervascular fibroids had larger diameter, which was greater than 6.0cm. These patients first received RF treatment and HIFU were used to treat residuals guided by the CEUS results. All 56 patients undertook conventional ultrasound, CDFI, CEUS examines and 49 patients received ultrasound guided needle puncture biopsy one week before and after this combined treatment.Results: CDFI showed the blood supply in the fibroids decreased after the HIFU/RF treatment. However, after combined RF/HIFU treatment, the blood flow signals decreased significantly. The CEUS indicated that 32 patients (91.4%) had no contrast agent infusion after HIFU combined RF treatment. And in RF combined HIFU treatment group 2 patients had contrast agent infusion while 19 patients (90.5%) with no contrast agent infusion during the whole procedure. Pathological results showed that coagulative necrosis in the treated region with distorted cells, shrinkage of nuclei, cell debris were found after this combined treatment. in HIFU combined RF group, 26(92.9%)patients samples became damaged tissues. Smooth muscle cell hyperplasia were found in 2(7.1%)patients samples. In RF combined HIFU group, higher magnification showed disruption of cytomembrane, pyknotic nuclei and caryorrhexis in 18(85.7%) patients. Hyperplasia of smooth muscle cell can be found in 2(9.5%)patients samples. One patient didn't obtain the valid sample.Conclusion: The pathological results and imaging founding demonstrated the combined treatment was effective in treating big fibroids with abundant blood supply. The effective rate was higher than 85%. Part Three A comparative study of radiofrequency ablation and combined RF and HIFU treatment in treating uterine fibroidsObjective: To compare the therapeutic efficacy and complications incidence rate of RF and combined therapy in uterine fibroids treatment by using contrast enhanced ultrasoundMethods:From January 2009 to September 2009, 78 patients with hypervasxular uterine fibroids were treated with HIFU and RF combined therapy and simple RF treatment respectively in Xijing hospital. The diameter ranges of the fibroids were 4.0cm-9.6cm, and the blood supply were G2 and G3. Contrast enhanced ultrasound (CEUS) was used to compare image changes of these two treatments. There was no significant difference in age, the size of the fibroids and the blood supply between the two groups(U test and Mann-Whitney Test, p>0.05). All the patients received CEUS exam one week before and after the treatment. The ablation effect, completely ablation rate and the incidence rate of complications were compared by statistical analysis.Results: Forty-five patients had no contrast agent infusion in the combined treatment group; the effective rate was 91.8%. Twenty-one patients had no contrast agent infusion in the simple RF treatment group; the effective rate was 72.4%. The efficacy of the combined treatment was higher than the simple RF treatment. There was significant difference between the two groups(p<0.05). 8.2% (4/49) patients got fever in combined treatment group after treatment while 27.6 %( 8/29) patients in simple RF group (p<0.05). Five(10.2%)patients got fluid of pelvic cavity in combined treatment group after treatment while eleven(37.9%) patients in simple RF group (p<0.05). Two patents (4.1%) appeared colporrhagia in combined treatment group and six (20.7%) patients in simple RF treatment group. Besides, 3(23.8%) patients in the combined treatment group got coccydynia after the treatment. The pain disappeared in one week and didn't receive treatment. No severe complications happened in both treatments.Conclusion: HIFU and RF combined treatment and simple RF treatments were effective in treating hypervascular uterine fibroids. The completely ablation rate was higher in combined treatment than in simple RFA. The combined treatment had lower incidence rate of complications than simple RF treatment, there had significant differences between the two treatments. Therefore, this combined treatment will be good alternative for hysterectomy in treating hypervascular fibroids.