MR引导高强度聚焦超声治疗子宫肌瘤的Meta分析

MR guided focused ultrasound for treating uterine fibroids：a Meta analysis

目的探讨MR引导高强度聚焦超声（MRgFUS）治疗子宫肌瘤的近期疗效及安全性，为此治疗方式在临床的广泛开展提供循证医学依据。方法计算机检索Cochrane Library、PubMed、EMbase、中国生物医学文献数据库（CBM）、中国知网（CNKI）、维普和万方数据库及手工检索已公开发表的有关MRgFUS治疗子宫肌瘤的文献，按纳入及排除标准由2名研究者独立进行文献的筛选、资料提取和质量评价后，采用Comprehensive Meta-Analysis V2软件进行Meta分析，计算非灌注体积比（NPVR）、肌瘤收缩率、临床症状严重程度（SSS评分）和不良反应情况。结果共纳入19篇文章、1549例患者。Meta分析结果显示：（1）NPVR平均值为57.1%（95%CI 45.0%～69.2%）；（2）肌瘤收缩率平均值为31.4%（95%CI 29.2%～33.6%）；（3）SSS评分：术前基本评分为51.00（95%CI 41.61～60.40），3个月后评分为32.50（95%CI 25.90～39.10，），6个月后评分为28.62（95%CI 23.57～33.66），12个月后评分为24.46（95%CI 15.44～33.49），随着时间变化，SSS评分有降低趋势；（4）不良反应程度均较轻且能自行缓解，较少会出现严重的不良反应。结论现有证据提示， MRgFUS治疗子宫肌瘤的近期疗效确切且安全性较高，可明显缩小肌瘤体积，降低患者临床症状的严重程度。

Objective To investigate the recent effect and safety of magnetic resonance guided focused ultrasound （MRgFUS） for treating uterine fibroids with a Meta analysis. Methods Such databases as Cochrane Library,PubMed,EMbase, CBM,CNKI,CQVIP and Wanfang were searched from their establishment. After thestudy selected, assessment and data extraction conducted by two reviewers independently, Meta-analysis were performed by using the Comprehensive Meta-analysis V2 software. The volume of non-perfusion ratio （NPVR）, fibroid shrinkage, clinical symptom severity （SSS score） and adverse reactions were analyzed.Results Nighteen retrieved articles were included, with a total of 1 549 patients. The results of Meta-analysis showed that：（1）nonperfused volume ratio （NPVR）,Mean=57.1%（95%CI 45.0% —69.2%）.（2）Percentage of FBs shrinkage：mean=31.4% （95% CI 29.2% —33.6%）.（3）Symptom severity score （SSS）：baseline mean=51.00（95%CI 41.61—60.40）,3 months mean=32.50 （95%CI 25.90—39.10）,6 months mean=28.62（95%CI（23.57—33.66）,12 months mean=24.46（95%CI 15.44—33.49）, the average of the severity score of the patient symptoms had a tendency to reduce.（4）The degree of adverse reactions were mild and could relieve itself, there was fewer serious adverse reactions. Conclusions The current evidence indicates that MRgFUS in treatment of uterine fibroidsis reliable and safe. MRgFUS can significantly reduce the volume and the symptom severity score ofthe patients.