Abstract

Objective

To evaluate the clinical effects of image-guided thermal ablation for the treatment of symptomatic adenomyosis (AD).

Data sources

We searched PubMed, Web of Science, Cochrane Library, EMBASE, ClinicalTrials.gov and Google Scholar for literature from January 2000 to September 2020.

Methods of study selection

We included all studies reporting clinical outcomes of image-guided thermal ablation for AD, involving high-intensity focused ultrasound (HIFU), percutaneous microwave ablation (PMWA) and radiofrequency ablation (RFA). Two independent researchers performed study selection according to the screening criteria.

Results

A total of 38 studies representing 15,908 women were included. Compared with those at baseline, the visual analog scale scores, the symptom severity scores and the menorrhagia severity scores decreased significantly after these thermal ablation therapies. The mean ablation time was 92.18 min, 24.15 min and 31.93 min during HIFU, PMWA and RFA, respectively. The non-perfused volume ratio of AD was 68.3% for HIFU, 82.5% for PMWA and 79.2% for RFA. The reduction rates of uterine volume were 33.6% (HIFU), 46.8% (PMWA) and 44.0% (RFA). The reduction rates of AD volume were 45.1% (HIFU), 74.9% (PMWA) and 61.3% (RFA). The relief rates of dysmenorrhea were 84.2% (HIFU), 89.7% (PMWA) and 89.2% (RFA). The incidence of minor adverse events was 39.0% (HIFU), 51.3% (PMWA) and 3.6% (RFA). The re-intervention rates were 4.0% (HIFU) and 28.7% (RFA). The recurrence rate was 10.2% after HIFU. The pregnancy rates were 16.7% (HIFU), 4.93% (PMWA) and 35.8% (RFA).

Conclusion

Image-guided HIFU, PMWA and RFA may be effective and safe minimally invasive therapies for symptomatic AD.

中文翻译：

---

图像引导热消融治疗症状性子宫腺肌病：系统评价和荟萃分析

摘要

客观的

评估图像引导热消融治疗症状性子宫腺肌病（AD）的临床效果。

数据源

我们在 PubMed、Web of Science、Cochrane Library、EMBASE、ClinicalTrials.gov 和 Google Scholar 中搜索了 2000 年 1 月至 2020 年 9 月的文献。

研究选择方法

我们纳入了所有报告图像引导热消融治疗 AD 的临床结果的研究，包括高强度聚焦超声 (HIFU)、经皮微波消融 (PMWA) 和射频消融 (RFA)。两名独立研究人员根据筛选标准进行研究选择。

结果

共纳入 38 项研究，代表 15,908 名女性。与基线相比，这些热消融治疗后视觉模拟量表评分、症状严重程度评分和月经过多严重程度评分显着下降。HIFU、PMWA 和 RFA 期间的平均消融时间分别为 92.18 分钟、24.15 分钟和 31.93 分钟。HIFU 的 AD 非灌注体积比为 68.3%，PMWA 为 82.5%，RFA 为 79.2%。子宫体积缩小率分别为33.6%（HIFU）、46.8%（PMWA）和44.0%（RFA）。AD 体积的减少率为 45.1% (HIFU)、74.9% (PMWA) 和 61.3% (RFA)。痛经缓解率分别为84.2%（HIFU）、89.7%（PMWA）和89.2%（RFA）。轻微不良事件的发生率为 39.0% (HIFU)、51.3% (PMWA) 和 3.6% (RFA)。再干预率分别为 4.0% (HIFU) 和 28.7% (RFA)。HIFU后复发率为10.2%。妊娠率为 16.7% (HIFU)、4.93% (PMWA) 和 35.8% (RFA)。

结论

图像引导的 HIFU、PMWA 和 RFA 可能是治疗症状性 AD 的有效且安全的微创疗法。