ObjectivesTo systematically review the safety and effectiveness of uterine artery embolization (UAE), surgery and high intensity focused ultrasound (HIFU) in the treatment of uterine fibroids.MethodsPubMed, EMbase, The Cochrane Library, Web of Science, WanFang Data and CNKI databases were electronically searched to collect relevant studies on comparing the safety and effectiveness of UAE, surgery and HIFU in the treatment of uterine fibroids from January 2000 to August 2019. Two reviewers independently screened the literature, extracted the data and evaluated the risk of bias of included studies, network meta-analysis was performed by ADDIS 1.16.8 software and Stata 14.0 software.ResultsA total of 11 trials (22 references) involving 3469 patients were included. Compared with surgery, UAE and HIFU patients had higher quality of life (1-year follow-up) improvement, and UAE was higher than HIFU. Network meta-analysis showed that patients treated with HIFU had the lowest incidence of major complications within 1 year, followed by UAE, and surgery. Patients treated with HIFU and UAE had shorter hospitalization and quicker recovery time than surgery. The rate of further intervention after surgery treatment might be lower than that of UAE and HIFU.ConclusionsUAE has the highest quality of life improvement (1-year follow-up) for uterine fibroids. HIFU and UAE are safer with shorter hospital stays and quicker recovery time compared with surgery. However, both UAE and HIFU have the risk of re-treatment. However, limited by the number and quality of included studies, the above conclusions are needed to be verified by more high-quality studies.
Vascular perfusion distribution in fibroids contrast-enhanced ultrasound images provides useful pathological and physiological information, because the extraction of the vascular perfusion area can be helpful to quantitative evaluation of uterine fibroids blood supply. The pixel gray scale in vascular perfusion area of fibroids contrast-enhanced ultrasound image sequences is different from that in other regions, and, based on this, we proposed a method of extracting vascular perfusion area of fibroids. Firstly, we denoised the image sequence, and then we used Brox optical flow method to estimate motion of two adjacent frames, based on the results of the displacement field for motion correction. Finally, we extracted vascular perfusion region from the surrounding background based on the differences in gray scale for the magnitude of the rich blood supply area and lack of blood supply area in ultrasound images sequence. The experimental results showed that the algorithm could accurately extract the vascular perfusion area, reach the precision of identification of clinical perfusion area, and only small amount of calculation was needed and the process was fairly simple.
ObjectiveTo evaluate the efficacy of myomectomy via transumbilical laparoendompic single-site surgery (TU-LESS) and traditional multiport laparoscopy.MethodsThe study was conducted at Chengdu Western Hospital from June 2019 to June 2020. Fifty patients underwent TU-LESS myomectomy (TU-LESS group), while another 50 patients underwent traditional multiport laparoscopic myomectmy (multiport laparoscopy group). The conditions of operation, extra analgetic usage, VAS grade, and patients’ satisfaction degree were compared between two groups.ResultsPatients in both groups had similar age, BMI, fibroma volume, operative time, expelling gas day, blood loss, complication rate, and hospitalized costs (P>0.05). Compared with traditional multiport laparoscopy, the TU-LESS group resulted in significantly shorter hospitalization day, lower VAS score of the 1st/3nd/7th days after surgery, less use of analgetic after surgery, and higher satisfaction degree.ConclusionsTU-LESS is safe and feasible for myomectomy, and it is associated with less pain, shorter hospitalization day, and higher satisfaction degree.
Objective To analysis the safety of high-intensity focused ultrasound (HIFU) in the treatment of uterine fibroids and provide references for clinical practice and prevention of complications of gynecological diseases. Methods Databases including PubMed, The Cochrane Library (Issue 2, 2016), EMbase, CBM, CNKI, and VIP were searched to collect studies concerning the complications of HIFU for uterine fibroids from March 1st 2005 to February 15th 2016. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies. Then, meta-analysis was performed by using R software. Results A total of twenty studies involving 2 405 patients were included. The results of meta-analysis showed that complications rate of gynecological system induced by HIFU was 6.63% (95%CI 3.58% to 12.28%); among them, the incidence of vaginal bleeding was 5.82% (95%CI 3.22% to 10.53%), and the incidence of abdominal pain was 10.02% (95%CI 4.77% to 21.05%). Conclusion The current evidence shows that there is a certain amount of complications of HIFU for uterine fibroids. Due to the limited quantity and quality of included studies, the above results are needed to be validated by more studies.
Objective To systematically review the effectiveness and safety of high intensity focused ultrasound (HIFU) for myoma of uterus fibroid. Methods Such databases as PubMed, EMbase, Web of Science, The Cochrane Library (Issue 10, 2012), CBM, CNKI, and WanFang Data were electronically searched from inception to November 2012 for randomized controlled trials on HIFU for myoma of uterus fibroid. Two reviewers independently screened literature according to inclusion and exclusion criteria, extracted data, and assessed the methodological quality of the included studies. Then, meta-analysis was performed using RevMan 5.0 software, and the quality levels of evidence were graded using GRADEpro 3.2 software. Results A total of 6 trials were included, involving 643 patients. The results of meta-analysis showed that, HIFU was similar to surgery in complete and partial fibroid ablation, with no significant difference; HIFU and radiofrequency were different in complete and partial fibroid ablation, with significant differences; and HIFU was superior to mifepristone in complete fibroid ablation, with a significant difference. Conclusion HIFU is an alternative, non-invasive, safe and effective treatment for myoma of uterus fibroid.
ObjectiveTo probe into the clinical efficacy of high-intensity focused ultrasound (HIFU) alone for uterine fibroids. MethodBetween February 2012 and February 2014, 145 patients with 174 cases of uterine fibroids were treated with HIFU. Before and one day, 6 months, 12 months after treatment, MRI was performed during the follow-up. We analyzed fibroids narrowing rate, adverse reactions, and clinical symptoms improvement after treatment. ResultsSuccessful completion of HIFU ablation was done for all the fibroids. Enhanced MRI examination before and one day after treatment, and MRI plain scanning 6 and 12 months after treatment showed that fibroid volume before treatment was 4.61-419.70 cm3 (median of 56.82 cm3), fibroid volume after treatment was 3.02-578.21 cm3 (median of 56.74 cm3), ablation volume was 2.42-578.21 cm3 (median of 47.84 cm3), and volumetric ablation rate was 24%-100%; there was no statistically significant difference in fibroid volume before and after treatment (P>0.05); fibroid volume 6 months after treatment was 0-264.50 cm3 (median of 22.49 cm3) and was 0-346.02 cm3 (median of 14.81 cm3) 12 months after treatment with a reduction rate of 60.4% and 73.9% on average respectively, and the volume was significantly different between those two time points and before treatment (P<0.05), and between 6 months and 12 months after treatment (P<0.05). The medians of uterine fibroid symptoms (UFS) and quality of life (QOL) scores before ablation were respectively 21.88 and 71.55 points. UFS reduced by 57.1% and 71.4% respectively 6 and 12 months after ablation, and QOL increased by 15.7% and 26.5% at those two time points. Both UFS and QOL 6 and 12 months after treatment were significantly different from that before treatment (P<0.05), and the UFS and QOL difference between 6 months and 12 months after treatment was also significant (P<0.05). As time went on, UFS gradually reduced, while QOL gradually increased. Complication rate was 2.8% with two cases of skin shallow degree-Ⅱ thermal damage, one of lower limb radiation pain, one of urinary retention, and there were 6 cases of recurrence during the follow-up. ConclusionsHIFU treatment for uterine fibroids is safe and effective, and is an alternative choice for conventional treatment when it is unable to retain the womb or when the patient refuses surgical treatment.
Objective To systematically evaluate the effectiveness and cost of laparoscopic myomectomy (LM) vs. traditional abdominal myomectomy (TAM) in treating Chinese patients with hysteromyoma. Methods Such databases as The Cochrane Library (Issue 4, 2012), PubMed, EMbase, CNKI, CBM and WanFang Data were searched from their inception to September, 2012 to collect the randomized controlled trials (RCTs) about LM vs. TAM in treating Chinese patients with hysteromyoma, and the references of the included studies were also retrieved. Two reviewers independently screened the literature according to the inclusion and exclusion criteria, extracted the data and assessed the methodological quality. Then meta-analysis was conducted using RevMan 5.2 software. Results A total of 8 RCTs involving 1 000 Chinese patients were included. The results of meta-analysis showed that, LM was superior to TAM in postoperative exhaust time (WMD= ?15.21, 95%CI ?20.19 to ?10.24, Plt;0.000 01) and postoperative hospital stay (WMD= ?3.07, 95%CI ?4.25 to ?1.90, Plt;0.000 01), with significant differences. But it was inferior to TAM in operation time (WMD=28.33, 95%CI 18.07 to 38.59, Plt;0.000 01) and hospital costs (WMD=2 028.87, 95%CI 1 190.75 to 2 866.98, Plt;0.000 01), with a significant difference. There was no significant difference in intraoperative bleeding amount between the two groups (WMD= ?2.78, 95%CI ?41.56 to 36.00, P=0.89). Conclusion This study shows LM is superior to TAM in fastening postoperative recovery and shortening hospital stay, but it is longer in operation time and higher in cost. The intraoperative bleeding amount is similar in the two groups. Due to low methodological quality and small sample size of the included studies, this conclusion has to be further proved by more high-quality RCTs.
【摘要】 目的 比较腹腔镜和开腹子宫肌瘤切除术在术后第1周的临床效果。 方法 将2008年1月-2009年12月收治的34例子宫肌瘤患者随机分为腹腔镜组17例，开腹组17例。所有患者均为肌壁间肌瘤或浆膜下肌瘤，肌瘤直径在5~15 cm之间且数目≤3个。 结果 两组患者手术时间相近；腹腔镜组术后体温恢复正常时间、肛门排气时间、排尿时间均短于开腹组（Plt;0.05）；腹腔镜组、开腹组术后血红蛋白下降更为明显（Plt;0.05）；术后7 d，开腹组腹痛视觉模拟评分明显高于腹腔镜组（Plt;0.05）。 结论 腹腔镜下子宫肌瘤切除术具有创伤小、恢复快、疼痛轻等优点,是一种安全有效的手术方法。【Abstract】 Objective To compare the outcome of myomectomy performed by laparotomy and laparoscopy in the first 7 days after surgery. Methods Thirty-four patients with myoma less than three and in diameter of 5-15 cm from January 2008 to December 2009 were randomly divided into laparotomy group and laparoscopy group. Results Operation lengths were similar in the two groups. Time of paralytic ileus (Plt;0.05) and discharge (Plt;0.05) were longer in laparotomy group than laparoscopy group. Compared with laparoscopy group, laparotomy group had a greater hemoglobin decline (Plt;0.05). Time of post-operation fever were longer in laparotomy group than laparoscopy group (Plt;0.05). Seven days after surgery, the visual analogue scores of abdominal pain were higher in laparotomy group than in laparoscopy group (Plt;0.05). Conclusion Compared with the laparotomy myomectomy, laparoscopy myomectomy have mini trauma, quicker post operative recovery, and less pain. This method is safe and effective.