Analysis Of Three Methods In The Treatment Of Uterine Leiomyoma

ObjectiveTo provide a reference for the future treatment of uterine leiomyoma, the efficacy of uterine arterial embolization(UAE), radiofrequency ablation and myomectomy were observed and their cost-effectiveness analysis were done in this study.Methods1.Clinical dataThe clinical data and pathological result of the medical records of 141 uterine fibroids patients were retrospectively reviewed from September 2008 to May 2009. All patients were aged from 30 to 50,meeting indications and intact data.Among those patients,56 cases were treated by myomectomy,34 cases were treated by uteroine arterial embolization and 51 cases were treated by radiofrequency ablation,.1. Technical routeEach operation has been completed by the clinician who has completed more than 20 cases of the same operation. Some indicators were compared, including operative time, intraoperative reactions, complications and the follow-up results of B-ultrasound symptoms, serum estradiol (E2), follicle stimulating hormone (FSH) levels of these three groups, and its cost-effectiveness analysis were be done.The E2 and FSH levels were determined by electrochemiluminescence(ECL).3. Effective criteriaCure The tumor and clinical symptoms disappeared completely.Improvement The tumor size was decreased and symptoms was improved, but they did not completely disappear.Failure After 6 months, the leiomyoma's mass did not change or was even increased. The leiomyoma's density did not change; the clinical symptoms were not improved.4. Statistical analysisSPSS12.0 and SAS statistical software was used to establish a database and do statistical analysis. The quantitative data were analyzed with analysis of variance (ANOVA) or t test and the qualitative data were analyzed withχ2 test. The significant level was setting at a=0.05.Results 1 Basic dataThere were no significant difference in the age and multiple of three groups.There were significant difference in the diameter of there groups.2 Operation time and hospital stayOperation time There were no significant difference in the average operation time of myomectomy group and UAE group(P=0.059). The operation time of radio frequency ablation was around 45 min and had statistically significant differences between the two groups.Hospital stay The average hospital stay of myomectomy group and UAE group were around 8.8d and 4.5d, and there were significant differences between the two groups. The Ablation group was not hospitalized.3 EffectivenessAfter 3 and 6 months, the diameters of uterine leiomyoma were reduced to 38.14% and 56.86% in UAE group,37.31% and 63.46% in Ablation group, respectively. The efficiencies of these three groups were 98.21%,97.06% and 96.08%, respectively and there had no significant differences. The internal structure of efficient had significant differences. The cure rates of these three groups were 92.86%,50.00% and 76.47%, respectively.4 ComplicationsIn the group of myomectomy, one case had bleeding, five cases had flatulence, three cases were infected, seven cases had a low grade fever and two cases of wound were healing. In UAE group, twenty three cases had pelvic pain in the embolization, fourteen cases had embolism syndrome and one case had subcutaneous ecchymosis on hip after embolization;the vaginal discharge of six cases had increased after ten or twenty days. In ablation group, forty three cases had abdominal pain in the ablation and 3 cases had abortion syndrome after treatment. All these symptoms were cured after symptomatic treatment.5 Hormone levelsIn the group of myomectomy, the levels of E2 (pmol/L) were 394±102,346±101, and 398±108 before and after treatment 1 and 6 months, and the FSH (U/L) level were 8.12±1.15,10.13±1.42,8.19±1.29 before and after remove leiomyoma 1 and 6 months. In this group, these two hormone were all have significant differences before and after 1 months of operation(P=0.021).There was no significant differences before and after treatment in UAE group and Ablation group. 6 Cost-effectiveness analysisThe C/E of myomectomy group, UAE group and ablation group were 55.31,86.05 and 38.72. The sensitivity analysis showed that the results were reliable.Conclusions1 The efficiency of these three kinds of therapy were similar. The radio frequency ablation group had the shortest treatment and recovery time,and its economic evaluation was best.2 Myomectomy could made short-term decline on ovarian function after treatment, and other two methods had no significant negative impact on ovarian function.