| Background: In benign tumors among the female, one of the most common is uterine fibroid, which often occurred in 30 to 50 year-old women, with the incidence of 20%- 25% during their reproductive ages, and it has increasing incidence and a trend of younger in recent years. It often occurs with multiple fibroids, which is most commonly appearing as intramural myoma, whose cause is not currently confirmed, and it is mainly considered to be related with female sex hormones. Clinical manifestations of uterine fibroids mainly displays as menorrhagia, prolonged menstruation, lumbar and sacral pain, frequent urination, urinary retention, constipation, infertility, abortion and etc. Multiple uterine fibroids are difficult to be treated due to large number and unfixed location, and can be accompanied with a variety of types, so clinical symptoms are often significant. Treatments for multiple uterine fibroids are divided into surgery and non-surgical treatment. Surgical treatments are inc luding abdominal or laparoscopic surgical myomectomy, hysterectomy, hysteroscopic myomectomy. Non-surgical treatment are mainly including drug therapy, radiofrequency ablation, UAE(Uterine Arterial Embolization), and HIFU(High intensity focused ultrasound) ablation, which is ris ing in recent 10 years. For the treatment to multiple uterine fibroids accompanied with submucosal uterine fibroids, any of the treatments mentioned above has its weakness, strength, and also limitations when is chosen to work alone.Objective: to study the safety and effectiveness of the HIFU combined hysteroscopic treatment for the multiple uterine fibroids accompanied with submucous myoma, and the influence on pregnancy outcome, to explore its clinical value.Materials and methods: to choose 20 cases in November 2011 to September 2015 from Haifu hosital, which belongs to the first affiliated hospital of chongqing medical university, the 20 patients with submucosal multiple uterine fibroids had underwent HIFU combined hysteroscopic treatment. The inclusion criteria and exc lus ion criteria are related to submucosal multiple uterine fibroids. Hospitalized cases aged 28 ~ 52 and the average age is 37.33-6.81. Patients with preoperative MRI vis ible ranged from 2 to 9 fibroids, the total fibroids number is 68 and the average is 3.78 ±1.99. Each patient has 1~3 submucosal uterine fibroids and total number is 25. The minimum diameter is 1cm and the maximum is 6 cm. The largest average size is 3.56 + 1.20 cm. Through the postoperative MRI T1 WI enhanced image, we measured the various lines of perfusion area, calculated the perfusion volume and the ablated rate. Have a follow-up in patients at 3, 6 months after surgery to check the fibroid volume change and calculate the shrunken rate. Have a follow-up when 6 months after postoperative to check symptoms improvement of the patients. Statistics the pregnancy and birth outcomes of patients with fertility requirements.Results: 1. In this study, 20 patients were successfully completed HIFU ablation and hysteroscopic resection of submucous uterine myoma. There are no serious complications before and after treatment with a SIR A-B level evaluation, main manifestations are lower abdominal pain, vaginal abnormal drainage, lumbar and sacral pain, one of the most common adverse reactions is lower abdominal pain, no other serious complications occurred.2. Fibroids average ablation rate in this study was 71.15%±19.66%). Fibroids with ablation rate > 50% accounts for 82.35%. Postoperative follow-up are fibroids 30 after 3 months, and its uterus volume shrink average rate is 40.15%±11.35%. Postoperative follow-up fibroids are 26 after 6 months, and its uterus volume shrink average rate is 61.37%±10.56%. Preoperative and postoperative myoma shrinkage rate was statistically significant(P < 0.05). Postoperative 6 months follow-up showed menorrhagia, pain, frequent urination, dizziness, fatigue symptoms were relieved, and remission rate was 94.12%.3. Among patients who have fertility requirements, 3 cases(3/15) are postoperative pregnancy, 2 cases(2/15) are natural pregnancy, 1 case is assisted reproduction(1/15). No related complications occurred during pregnancy. 3 cases are cesarean delivery(2 cases are due to obstetric factors, 1 case is social factor), no severe intrapartum complications.Conclusions: HIFU combined hysteroscopic treatment for multiple uterine fibroids accompanied with submucous myoma is safe and effective, and it overcomes the limitations of the single treatment, and is the path of noninvas ive treatment advantage superposition solution, is the better choice of the expression of treatment to minimize harm to patients, which is positive to pregnancy and fertility. There is no obvious adverse effect, and it occupied a high value in the treatment of multiple uterine fibroids, which is worthy of research and promotion. |
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