超声引导经皮微波消融治疗症状性局灶型子宫腺肌病的中期疗效

Mid-term outcomes of ultrasound-guided percutaneous microwave ablation for symptomatic focal uterine adenomyosis

目的评估超声引导经皮微波消融(ultrasound-guided percutaneous microwave ablation,US-guided PMWA)治疗症状性局灶型子宫腺肌病的局部治疗反应和中期效果。方法从2020年3月—2022年1月,47例有症状的局灶型子宫腺肌病患者纳入本研究。在24个月的随访中,评估并记录子宫体积、腺肌病病灶体积、视觉模拟量表(visual analogue scale,VAS)评分、血红蛋白(hemoglobin,Hb)、症状严重程度评分(symptom severity score,SSS)、健康相关生活质量(health-related quality of life,HRQL)评分和并发症。结果所有47例患者都成功接受了US-guided PMWA治疗,没有出现重大并发症。中位随访时间为12.0(6.024.0)个月。在24个月的随访中,术后子宫腺肌病病灶的体积缩小率(volume reduction rate,VRR)达到68.1%。与术前的基线值相比,42例妇女病灶体积减小了50.0%以上。中位子宫VRR达到38.1%。VAS评分从8.0(7.09.0)降至1.0(0.02.5),差异有统计学意义(P<0.001);中位Hb水平从117.0(100.8127.5)g/L增加至131.0(118.5138.0)g/L,差异有统计学意义(P=0.023)。同时,术后SSS和HRQL评分与MWA之前的评分差异有统计学意义(P均<0.05)。结论US-guided PMWA治疗子宫腺肌病的中期效果良好且无严重并发症,是治疗症状性局灶型子宫腺肌病的一种替代策略。

Objective To assess the local treatment response and mid-term outcomes of ultrasound-guided percutaneous microwave ablation(US-guided PMWA)in the treatment of symptomatic focal uterine adenomyosis.Methods Clinical data of 47 patients with symptomatic focal uterine adenomyosis treated with US-guided PMWA from March 2020 to January 2022 were retrospectively analyzed.Uterine volume,adenomyosis volume,visual analogue scale(VAS)score,hemoglobin(Hb),symptom severity score(SSS),health-related quality of life(HRQL)score and complications were evaluated at 24-month follow-up.Results All 47 patients successfully underwent US-guided PMWA without major complications.The median follow-up time was[12.0(6.024.0)]months.At 24 months of follow-up,a 68.1%volume reduction rate of adenomyosis was reached.The volume reduction rate(VRR)of lesions was reduced by more than 50.0%compared to the preoperative baseline value in 42 cases,the median uterine VRR reached 38.1%.The VAS score decreased from 8.0(7.09.0)to 1.0(0.02.5)(P<0.001).The median Hb level increased from 117.0[(100.8127.5)]g/L to[131.0(118.5138.0)]g/L(P=0.023).Meanwhile,the postoperative SSS and the HRQL scores were significantly different from those before MWA(all P<0.05).Conclusion US-guided PMWA showed excellent mid-term results in the treatment of symptomatic focal adenomyosis without any major complications,which is a viable alternative strategy for the treatment of adenomyosis.