| ObjectiveIn this study,the clinical data of patients with type II submucosal uterine fibroids were retrospectively analyzed to evaluate the efficacy of high intensity focused ultrasound(HIFU)in the treatment of type II submucosal uterine fibroids,and compared with hysteroscopic myomectomy(TCRM).MethodsThe data of the hospitalized patient with diagnosis of type II submucosal uterine fibroids in Northwest Women and Children’s Hospital between August 1,2017 and July 31,2018 were retrospectively analyzed and treated with HIFU or TCRM.Based on different treatment methods,they were divided into two groups:46 cases in HIFU group were treated with high intensity focused ultrasound ablation,and 59 cases in TCRM group were treated with hysteroscopic myomectomy.Therefore,This topic is divided into two parts,the first part analyzes the HIFU treatment of type II submucosal uterine fibroids in each stage of efficacy;the second part of the comparative analysis of HIFU and TCRM treatment of type II submucosal uterine fibroids clinical efficacy.Section one:Through analyzing the clinical data of HIFU group,the changes of fibroids volume,uterine fibroids related symptoms(UFS)score,quality of life(QOL)score and hemoglobin(HGB)were compared before treatment and 3,6,12 and 24 months after treatment,and the efficacy of HIFU in the treatment of type II submucosal uterine fibroids was analyzed.Section two:Through analyzing the clinical data of patients in HIFU group and TCRM group,the myoma volume,UFS score,QOL score,HGB,treatment time,hospitalization time,hospitalization expenses and adverse reactions of the two groups were compared.Thus,The clinical efficacy of two methods were evaluated.ResultsSection one1.HIFU group compared with before treatment,after treatment 3 months,6 months,12months,24 months uterine fibroids volume reduction rate were 26.07%,50.74%,71.47%,81.81%.2.The UFS score in the HIFU group showed a downward trend after treatment,and the UFS score after 3 months of treatment was statistically different from that before treatment(17.04±4.04VS23.11±5.61,P<0.001).The UFS scores at 6 months after treatment were significantly different from those at 3 months after treatment(10.52±1.88VS17.04±4.04,P<0.001).There was no significant difference in UFS score between 12 months after treatment and 6 months after treatment(P=0.085);There was no significant difference in UFS score between 24 months after treatment and 12 months after treatment(P=0.444).3.The QOL score of HIFU group showed a downward trend after treatment,and there was no significant difference in QOL score 3 months after treatment compared with that before treatment(P=0.396).There was no significant difference in QOL score between 6 months after treatment and 3 months after treatment(P=0.740);There was a statistically significant difference in QOL score between 12 months after treatment and 6 months after treatment(41.20±10.76VS71.04±19.91,P=0.008).There was a statistically significant difference in QOL score between 24 months after treatment and 12 months after treatment(36.39±6.62VS41.20±10.76,P<0.001).4.HGB in HIFU group showed an upward trend after treatment,and there was no significant difference in HGB after 3 months of treatment compared with that before treatment(P=0.100).There was a statistically significant difference in HGB between 6 months after treatment and 3 months after treatment(117.48±13.03 VS 105.65±16.13,P<0.001).There was no significant difference in HGB between 12 months after treatment and 6 months after treatment(P=0.989).5.Linear regression analysis of the ablation rate of type II submucosal uterine fibroids:CDFI grade and T2W1 signal intensity of fibroids are the main factors affecting the ablation rate.The ablation rate of myoma in CDFI II was significantly lower than that in CDFI I(β=-3.32,P=0.044),and that in CDFI III was significantly lower than that in CDFI I(β=-13.34,P<0.001).There was no significant difference in the ablation rate between T2W1 low signal and T2W1 signal fibroids(P=0.086).The ablation rate of T2W1 high signal fibroids was significantly lower than that of T2W1 low signal fibroids(β=-10.94,P=0.002).Section two1.Seven of 59 patients in TCRM group had residual myoma after operation.The complete resection rate of TCRM was 88.14%.2.The UFS score of HIFU group at 3 months after treatment was significantly lower than that of TCRM group(17.04±4.04VS19.81±3.99,P=0.001).There was no significant difference between the two groups at 6,12 and 24 months after treatment(P>0.05).3.There was no significant difference in QOL scores between HIFU group and TCRM group before treatment and 3,6,12 and 24 months after treatment(P>0.05).4.There was no significant difference in HGB between HIFU group and TCRM group before treatment and 3,6,12 months after treatment(P>0.05).5.The hospitalization cost of HIFU group was higher than that of TCRM group(14641.71±2118.26 VS8828.22±2331.61,P<0.001).The hospitalization time of HIFU group was shorter than that of TCRM group(5.04±2.08VS6.56±2.01,P<0.001);The treatment time of HIFU group was shorter than that of TCRM group(43.04±25.10VS61.05±49.04,P=0.025).6.According to the classification system of complications established by the International Society for Interventional Radiology(SIR),there was no significant difference in the occurrence of adverse reactions in the HIFU group(16 cases)and the TCRM group(19 cases)(X~2=0.077,P=0.781).Level B adverse reactions occurred in HIFU group(1 case)and TCRM group(1 case);No C-level adverse reaction occurred in HIFU group,and C-level adverse reaction occurred in TCRM group(1 case);No D-F adverse reactions occurred in both groups.Conclusions1.After HIFU ablation of type II submucous myoma,the myoma gradually reduced,and the average volume of myoma decreased by more than 80%at 24 months follow-up.2.HIFU treatment of type II submucosal uterine fibroids can correct anemia,improve uterine fibroids-related symptoms and improve quality of life.3.The efficacy of HIFU in the treatment of type II submucosal uterine fibroids was equivalent to that of TCRM.4.HIFU treatment of type II submucosal uterine fibroids,treatment time and hospitalization time is short,less adverse reactions;However,HIFU is expensive at the moment.Specific treatment options should be based on the individual needs and economic ability of patients to give patients humanized and personalized treatment. |
