Effect Analysis Of Uterine Artery Embolization And High Intensity Focused Ultrasound In The Treatment Of Uterine Fibroids

Objective:To investigate the efficacy of high intensity focused ultrasound(HIFU)and uterine arterial embolization(UAE)in the treatment of uterine fibroids with different characteristics.Methods:The clinical data of patients diagnosed with uterine fibroids treated with UAE or HIFU at the First Affiliated Hospital of Kunming Medical University from October 2017 to June 2019 were collected and analyzed.All patients underwent MRI examinations before operation,and filled out Uterine fibroids severity and health-related quality of life(UFS-QOL)questionnaire and menstrual condition diary analysis card to calculate and record the size and number of fibroids,and the Magnetic resonance imaging characteristics of fibroids,including T1 weighted image and contrast enhanced(T1WI+C)(include mild,moderate,markedly enhanced),T2 weighted image(T2)Signal intensity(include low,equal,high,mixed signals),fibroid location(include anterior wall,lateral wall,posterior wall,fundus of uterus),fibroid classification(include subserosal,intermuscular,submucosal),Uterine position(include anterior,median,posterior).The types and frequency of adverse reactions during and after surgery were recorded.Patients underwent magnetic resonance examination at 6 months after surgery and refilled the UFS-QOL and menstrual diary analysis card.We calculated the volume of myoma at 6 months after surgery.Reduction rate and UFS-QOL and menstrual diary analysis card scores were used to evaluate the clinical efficacy of UAE or HIFU in the treatment of uterine fibroids with different characteristics.Results:A total of 53 patients with uterine fibroids met the inclusion criteria,including 23 in the UAE group and 30 in the HIFU group.The baseline data of the two groups were compared,including the number of fibroids,maximum fibroid type,maximum fibroid location,maximum fibroid T2 signal and maximum fibroid T1 enhancement signal.The differences between the two groups were not statistically significant(P>0.05).There was no statistically significant difference in the volume of uterine fibroids between the two groups at the 6th month after surgery,but there was statistically significant difference in the preoperative and postoperative volume of fibroids between the two groups(P<0.05).UFS-QOL score and menstrual score of the two groups at the 6th month after surgery were compared,and the differences were statistically significant(P<0.05).The clinical efficacy of the two groups was compared,and the difference was not statistically significant(P>0.05).There were 17 cases(73.91%)of AEs in UAE group,with different degrees of post-embolization syndrome and vaginal fluid flow.Among them,1 case(4.34%)developed myoma abscissa complicated with infection and recovered after anti-infection treatment.There were 24 cases(80%)AEs in HIFU group with different degrees of lower abdominal pain and vaginal fluid flow.No serious adverse events occurred in either group.Comparing the clinical efficacy of uterine fibroids with different MRI characteristics between the two groups,there was no statistically significant difference between single/multiple fibroids and different T2WI signal characteristics(P>0.05).There were statistically significant differences in location,type and T1 enhancement signal characteristics between the two groups(P<0.05).For uterine fibroids located in the posterior wall of the uterus,submucosal uterine fibroids and significantly enhanced T1WI,the clinical efficacy of UAE group was higher than that of HIFU group.Conclusions:1.UAE and HIFU can significantly reduce the size of fibroids with good safety,but UAE can significantly improve the symptoms in a short period of time(1-3 months after surgery);2.UAE have good curative effect of uterine fibroids on the posterior wall,submucosal,T2 WI high signal.