Safety And Efficacy Of Ultrasound-guided Percutaneous Microwave Ablation For Uterine Fibroid Of Different Types

1Objective To evaluate the safety and efficacy of ultrasound-guided percutaneousmicrowave ablation (PMWA) for uterine fibroids of different types.2Methods From February2010to February2014,150patients with150fibroidswho underwent PMWA were included. They were all from Department ofInterventional Ultrasound, Chinese PLA General Hospital according to the inclusionand exclusion criteria of this study. The mean ages of the patients were (40.5±5.2)years old (from30to52years old) and the mean diameters of the fibroids were(6.0±1.9)cm (from3.3to12.5cm). The fibroids were classified according to differentstandards:1) According to the International Federation of Gynecology and Obstetrics(FIGO) classification, the fibroids were classified as three types: submucosal fibroids(type0to type2), intramural fibroids(type3to type4) and subserosal fibroids(type5totype6).2) According to the locations of the fibroids, they were classified as5types:anterior fibroids, posterior fibroids, fundus fibroids, lateral fibroids, cervical fibroids.3)According to the mean diameters the fibroids were classified as3types: small fibroids:d＜5cm, medium fibroids:5cm≤d＜8cm, large fibroids: d≥8cm. Result analysis:①Safety analysis：Complications occurred within2years after the treatment wascategorized and graded as SIR A to SIR F by the complication classification developedby the Society of Interventional Radiology(SIR). No complications or SIR A and SIRB complications were defined as definitely safe, SIR C and SIR D as partially safe,SIR E and SIR F as unsafe.1) Safety analysis；2) Analyze the differences in safetyamong the fibroids of different types, different locations, different sizes and differentablated rates.②Clinical efficacy analysis: Analyze the clinical efficacy of thistechnique by comparing the changes of various indexes before and within2years aftertreatment. According to the evaluation standards of Tumor Response after treatment of formulated by UICC to create the standards of efficacy evaluation of this study.Effective: the FSR≥25%, clinical symptoms and quality of life relieved to the normallevel or got better; Invalid: the FSR<25%or no obvious relief or even exacerbation inclinical symptoms and qualities of life occurred.1) Changes in evaluating indicators:fibroid shrinkage rate (FSR), Uterine Fibroid Symptoms and Quality Of Life(UFS-QOL) Questionnaire and dosages of hemoglobin;2) efficacy analysis;3)Analyze the differences in efficacy among the fibroids of different types, differentlocations, different sizes；4) The recurrence of uterine fibroids.3ResultsPart One: safety analysis1.1General condition: Twenty-eight submucosal fibroids (type0six, type1ten, type2twelve), seventy-two intramural fibroids(type3twenty-seven, type4forty-five) andfifty subserosal fibroids(type5twenty-seven, type6twenty-three). Fifty anteriorfibroids, forty-eight posterior fibroids, thirty-three fundus fibroids, sixteen lateralfibroids, three cervical fibroids. forty-eight small fibroids, eighty-three mediumfibroids and nineteen large fibroids.1.2Therapy process: All the150patients went through the ablation treatment safelyunder stable vital signs. The safety of ultrasound-guided PMWA treatment forsymptomatic uterine fibroids was98.7%.1.3Adverse effects:150patients after treatment,148patients experienced no adverseeffect or SIR A or SIR B,2patients suffered from SIR C.1.4Fibroids of different types, different locations, and different sizes, no significantdifferences between SIRs were observed in the classification of significance (P>0.05).The discretion of the ablation rate and adverse reaction of SIR classification was of noobvious relationship.Part two: efficacy analysis2.1Follow-up: The mean time of follow-ups were12.84±9.44months (range,3～24months), of which the median follow-up time was12.5months.131,125,121, and82patients entered the3,6,12and24months follow-ups. 2.2The average effective rates at3-,6-,12-and24-months follow-up wererespectively99.24%,99.20%,98.35%and98.78%. Fibroids of different types,different locations, and different sizes, no significant differences were observed2.3The average fibroid volume shrinkage rates at3-,6-,12-and24-months follow-upwere respectively69.0%,82.9%,88.0%and91.1%. Compared with the other twotypes, the submucosal fibroids had the most obvious shrinkage rates.2.4Relief of anemia: They were all improved except for the two patients withrecurrence at6months follow-up.2.5Relief of symptoms and improvement of quality of life: There were statisticallysignificant difference with SSS and HRQL at3,6,12and24months follow-upscompared with baseline. Ablation symptoms and quality of life3~6months aftertreatment were improved nearly to the normal level, and that6~24months afterablation maintained in the same level without obvious change; The SSS and HRQLchange of the3types of fibroids were with no significant difference.2.6Fibroid recurrence within4years after ablation:2patients with ablated fibroidssuffered from fibroid recurrence.4conclusion1. PMWA could be a safe treatment for all types of uterine fibroids. The adverse effectshad nothing to do with the fibroids type, location, size and ablation rate;2. PMWA could effectively reduce fibroid volume, especially for the submucosalfibroids; With the shrinkage of fibroid volume, patients’ symptoms and qualities of lifeafter treatment could be obviously relieved at normal level which had no obviousrelationship with the fibroids types.