| Part Ⅰ Safety of ultrasound-guided lauromacrogol sclerotherapy for uterine fibroidObjective:To evaluate the safety of ultrasound-guided lauromacrogol sclerotherapy for uterine fibroids of different types,locations and sizes.Methods:From January 2014 to June 2017,128 patients with 142 fibroids were treated with ultrasound-guided lauromacrogol sclerotherapy in the Department of Interventional Ultrasound.The fibroids were classified according to different standards:1)According to the International Federation of Gynecology and Obstetrics(FIGO)classification,the fibroids were classified into three types:submucosal fibroids,intramural fibroids and subserosal fibroids.2)According to the locations,they were classified into five types:anterior fibroids,posterior fibroids,fundus fibroids,lateral fibroids,cervical fibroids.3)According to the sizes,the fibroids were classified into four types:d≤3cm,3cm<d≥5cm,5cm<d≥7cm,d>7cm.The vital signs and the starting time,extent,duration time of discomfort(pain,flushing,pale,sweating,palpitation,dyspnea,etc.)during the treatment of 128 patients were observed.Vital signs and the starting time,extent,duration time of adverse reactions(low fever,vaginal bleeding,vaginal fluid,infection,etc.)were evaluated after treatment.Results:1.All the 128 patients went through the treatment safely with stable vital signs.The safety rate of ultrasound-guided lauromacrogol sclerotherapy for uterine fibroid was 96.48%(137/142).2.Adverse effects:After treatment,70 experienced no adverse effect,53 and 5 suffered from SIR A and SIR B respectively.3.Factors influencing safety:Establishing a logistic model:Logistic(p)=0.559X1-0.198X2+0.072X3-17.441X4-18.688X5-16.377X6-0.231X7+17.738X8+19.372X9-20.873.The statistical analysis indicates that p value is more than 0.05.Therefore,there was no significant correlation between the safety and the types,locations,sizes of fibroids.4.Factors influencing the degree of abdominal pain and dosage of lauromacrogol:Except sizes,there was no significant difference in the dosage of lauromacrogol among different locations and types.There was a statistically significant difference in the degree of abdominal pain among patients with different sizes and types of uterine fibroids.Conclusion:Ultrasound-guided lauromacrogol sclerotherapy for uterine fibroids is a safe treatment with no serious adverse reactions during and after operation.The types,locations and sizes of fibroids have no effect on the safety.Part Ⅱ Short-term clinical efficacy of ultrasound-guided lauromacrogol sclerotherapy for uterine fibroidObjective:To evaluate the short-term efficacy of ultrasound-guided lauromacrogol sclerotherapy for uterine fibroids,and to compare the effectiveness of different types,different locations,different sizes of fibroids.To analyze the influence of type,location,size,blood flow,elastic scores of fibroids on the effective rates at 1 month follow-up and to make personal treatment plan based on the report.Methods:From January 2014 to June 2017,128 patients with 142 fibroids who underwent ultrasound-guided lauromacrogol sclerotherapy were included.They were all from Department of Interventional Ultrasound.Contrast-enhanced ultrasonography(CEUS)was performed to evaluate the effectiveness one month after by observing the contrast agent perfusion.Precise additional treatment was performed in the area with contrast agent perfusion.After one,three,six and twelve months respectively,the sizes,blood flow and elastic scores of fibroids were observed by two-dimensional(2D)ultrasound,color Doppler flow imaging(CDFI)and Real-time elastography(RTE).Blood routine was reviewed six months after surgery.These variables were compared with those before the surgery.All patients filled in the Uterine Fibroid Symptom and Health-Related Quality of Life questionnaire(UFS-QOL)both before and after the operation,and the Symptom severity score(SSS)and the health-related quality of life scale(HRQL)score were calculated.The standards of efficacy evaluation were created according to the characteristics of ultrasound sonogram before and after treatment.Significant effect:the Fibroid shrinkage rate(FSR)is higher than 50%,blood flow grade is 0,and elastic score is 4.In addition,no contrast agent perfusion was found and the clinical symptoms disappeared;Effective:with FSR being between 20%and 49%,blood flow grade being I,elastic score being 3,contrast agent perfusion found in part of the fibroids and clinical symptoms fading away;Invalid:with FSR being less than 20%,shrinking and expanding later,blood flow grade being II-III,elastic score being 1-2,contrast agent perfusion found in most part of the fibroids,no obvious relief found in clinical symptoms.Results:1.Follow-up:149,142,127,and 109 patients entered the 1,3,6,and 12 months follow-ups.2.Indexs evaluating effectiveness:①FSR:The average FSR after 1,3,6 and 12 months were(41.11 ± 1.863)%,(64.17±1.494)%,(75.06± 1.272)%and(81.14±2.102)%respectively.②Blood flow:blood flow in the fibroids gradually decreased with the increase of follow-up time.③Elastic score:elastic scores of fibroids increased with increasing follow-up time.④CEUS:1 month after surgery,53(37.3%)fibroids were found no contrast agent perfusion,46(32.4%)fibroids have contrast agent perfusion in the part,and 43(30.3%)fibroids be perfused with contrast media mostly,with an additional treatment being given immediately in the area with contrast agent perfusion.⑤Relief of anemia:They all improved at 6 months follow-up.⑥Relief of symptoms:One month after operation,SSS scores and HRQL scores improved the most,from(51.10±4.263)and(53.39±6.561)before surgery to(28.13±2.469)and(75.47±3.855)respectively.3 months after,SSS scores and HRQL scores were close to normal level(21.76±3.112,84.54±3.087)and they were stable at normal level after 6 and 12 months.3.Short-term efficacy:The effective rates at 1,3,6 and 12 months follow-up were 40.1%,77.3%,95.2%and 97.3%respectively.Binary logistic regression was used to analyze the factors affecting the effectiveness.The regression model equation was established:Y=6.391-2.858X3+1.084X5(with X3 representing the size of fibroids and X5 representing the elastic score).Only the sizes and elastic scores of fibroids were the influencing factors of validity of 1 months.Conclusion:1.Ultrasound-guided lauromacrogol sclerotherapy is convenient,inexpensive and can shrink fibroids,relief symptoms,improve quality of live.As such,ultrasound-guided lauromacrogol sclerotherapy has provided a new treatment for patients with uterine fibroids.2.Comprehensive evaluation of the efficacy with multiple indicators can accurately reflect the efficiency of the treatment. |
PDF Full Text Request