Abstract

Objective

To compare the efficacy and safety of high-intensity focused ultrasound (HIFU) and gonadotropin-releasing analogues (GnRH-a) as pretreatments for the hysteroscopic transcervical resection of myoma (TCRM) for type 2 submucosal fibroids greater than 4 centimeters in diameter.

Materials and methods

Seventy-nine patients were assigned into two groups according patient preference: 42 in HIFU and 37 in GnRHa. TCRM was performed after 3 months of pretreatment with HIFU or GnRHa.

Results

Following pretreatment with HIFU or GnRHa, uterine-fibroid symptom (UFS) scores and hemoglobin levels (HGB) showed improvement. The fibroid maximum diameter, size of fibroids, and volume of the uterus were decreased. Following HIFU pretreatment, one case reported complete vaginal fibroid expulsion, and four reported partial fibroid expulsion. No similar cases were found in the GnRHa group. Eighteen patients were lost to follow-up prior to TCRM. Among the 31 patients in HIFU, the fibroids were downgraded to type 0 in 10 cases and type 1 in 5 cases. Of the 30 patients in GnRHa, the treated fibroids were downgraded to type 1 in 9 cases. The mean operation time and intraoperative blood loss of the HIFU group were significantly lower than those in the GnRHa group. No significant differences were observed in the incidence of intraoperative complications and the one-time resection rate of fibroids between the two groups (p>.05).

Conclusions

HIFU seems to be superior to GnRHa as a pretreatment method prior to TCRM for type 2 submucosal fibroids greater than 4 centimeters in diameter

中文翻译：

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通过HIFU或GnRH-a预处理对直径大于4 cm的2型粘膜下肌瘤进行宫腔镜子宫肌瘤切除术的结果比较

摘要

客观的

为了比较高强度聚焦超声（HIFU）和促性腺激素释放类似物（GnRH-a）作为子宫内镜经宫颈宫颈肌瘤切除术（TCRM）的直径大于4厘米的2型粘膜下肌瘤的疗效和安全性。

材料和方法

根据患者的喜好，将79例患者分为两组：HIFU组42例，GnRHa组37例。用HIFU或GnRHa预处理3个月后进行TCRM。

结果

HIFU或GnRHa预处理后，子宫肌瘤症状（UFS）评分和血红蛋白水平（HGB）有所改善。肌瘤最大直径，肌瘤大小和子宫体积减小。HIFU预处理后，有1例报告说阴道纤维瘤完全排出，有4例报告了部分肌瘤排出。在GnRHa组中未发现类似病例。TCRM之前有18位患者失去随访。在HIFU的31例患者中，肌瘤降级为0型10例，降为1型5例。在GnRHa的30例患者中，有9例经治疗的肌瘤降级为1型。HIFU组的平均手术时间和术中失血量明显低于GnRHa组。p > .05）。

结论

对于直径大于4厘米的2型粘膜下肌瘤，在TCRM之前，HIFU似乎优于GnRHa作为预处理方法