| Objectives:Prospective comparative analysis of the effectiveness and safety of high-intensity focused ultrasound(HIFU)and gonadotropin-releasing hormone analogues(GnRH-a)pretreatment in the treatment of type 2 submucosal fibroids greater than 4 centimeters in diameter.Methods:Patients with type 2 submucosal fibroids diagnosed by magnetic resonance imaging(MRI)from January 2019 to December 2019 in the affiliated hospital of North Sichuan Medical College were collected,and the research objects were determined according to the inclusion criteria and exclusion criteria.After knowing and understanding,the patients were selected and divided into HIFU group and GnRH-a group.The symptoms and health-related quality of life questionnaire(UFS-QOL)scores,hemoglobin(HGB),maximum fibroid diameter,fibroid volume,uterine volume,and treatment effectiveness were recorded and analyzed before and after treatment in the two groups.After 3 months of pretreatment,hysteroscopic myomectomy was performed to record the changes in myoma types.Then the hysteroscopic resection time,intraoperative blood loss,perfusion fluid usage,one-time myotomy rate,the incidence of intraoperative complications were compared between the two groups.Results:1.42 cases were included in the HIFU group.One case was completely discharged and 4 cases were partially discharged after pretreatment.After HIFU treatment,the UFS-QOL score of the patients decreased significantly,and HGB increased significantly.Meanwhile,the largest diameter of fibroids,fibroid volume,and uterine volume were significantly reduced.Compared with treatment before,the differences were statistically significant(P<0.05).The GnRH-a group included 37 patients with no myoma excretion,and the differences were statistically significant compared with their indexes before treatment,too(P<0.05).2.The degree of change in the indexes of the two groups:the maximum diameter of fibroids in the HIFU group decreased by(14.26±9.24)mm,which was significantly better than that of the GnRH-a group(7.49 ±5.21)mm,and the difference was statistically significant(t=4.073,P<0.05);the average increase of HGB in the GnRH-a group was(21.76±11.63)g/L,which was significantly higher than that in the HIFU group(10.57±16.13)g/L,and the difference was significant statistically(t=-3.493,P<0.05);the UFS-QOL score,fibroid and uterine volume of the two groups decreased compared with those treatment before,but there was no significant difference in the decline(P>0.05).The overall effective rate in the HIFU group was 90.5%,which was significantly higher than the GnRH-a group's 64.9%,and the difference was statistically significant(?2=7.640,P<0.05).3.After 3 months of pretreatment:11 patients in the HIFU group had significantly relieved,and fibroids had shrunk significantly,so hysteroscopic resection was not performed;4 patients in the GnRH-a group underwent myomectomy in the outer hospital,and 3 patients in Total hysterectomy was performed outside the hospital.During hysteroscopic myomectomy,31 type 2 myomas in HIFU group changed to 5 type 1 and 10 type 0 respectively,and 16 patients were still type 2,but all patients were one-time cut.There were 30 cases in GnRH-a's.9 cases were converted to type 1 and 21 still type 2,but 3 patients'tumors were too large to cut at one time.There was no significant difference in the reduction rate between the two pretreatment methods(?2=2.160,P>0.05).4.Compared in the two groups of hysteroscopic surgery,the average operation time in the HIFU group was(27.68±10.23)min,the intraoperative blood loss(14.46±7.12)ml,and the average amount of perfusate was(675±279.72)ml,which were significant lower than those in the GnRH-a group,and the differences were statistically significant(P<0.05).There was no significant difference in the rate of one-time resection of fibroids and the incidence of intraoperative complications(P>0.05).Conclusions:1.HIFU and GnRH-a are both effective as pretreatments of type 2 submucosal myomas greater than 4 centimeters in diameter before hysteroscopic resection,but the overall efficiency of HIFU group is higher.2.Hysteroscopic myomectomy is safer and more effective after HIFU pretreatment,and it can be used as a first-line pretreatment method for larger type 2 submucosal fibroids. |
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