The Effect On Endometrial When HIFU Ablation The Submucosal Uterine Fibroids And How The Results Affect The Clinical Effect

Background:Uterine fibroids are the commonest benign tumor of reproductive sys-tem in women during their reproductive years, with morbidity up to20%~40%. According to the location in uterus, fibroids can be classified assubmucosal, intramural and subserosal. The submucosal fibroids accountsfor10%~15%of all. Because they can cause menorrhagia, menostaxis,even lead to post-hemorrhagic anemia or infertility, affect the patients’health severely. At present, the hysteroscope is the first-line therapy methodfor the efficacy and safety. But the long time follow-up find its high recur-rence, and the longer of operation, the more side effects may happen. In therecent years, with the medical pattern transformation and the develop ofminimally invasive or non-invasive theory, compared with conventionalsurgery of several damage and side effect, the minimally invasive treatmentreceived more and more attention. HIFU as a non-invasive technology, hasalready been focused on in the gynecology filed. With the advantage of non-invasive, conformal treatment and real-time monitoring, HIFU ablationthe submucosal fibroids has already been proved efficient. However, itstreatment of the submucosal fibroids may lead to part endometrial lesions.At the same time what is the effect of the damage to patients and how thedamage will outcome still need further research.Objective:1. Evaluate the clinical efficacy of HIFU ablation the submucosal fi-broids.2. Observe the injury of uterus in HIFU treatment of submucosal fi-broids and explore the effects of damage on the patients.Methods:1. Collect58patients with submucosal fibroid treated by HIFU. Cal-culate ablation rete and evaluate efficacy from the MRI image before andafter HIFU, analyze the follow-up of adverse reactions.2. Compare the change of endometrium on the MRI image before andafter HIFU. Divided into the intact group and the injured group. Compara-tive analyze fibroids classification, therapeutic effect and safety of patientsbetween the groups after HIFU.Results:1.58patients with submucosal fibroid include2type0,21type Ⅰand35type Ⅱ.After HIFU, the main adverse reactions in patients isvaginal discharge, bleeding.51patients suffered “fibroids tissue” output, included27patients in the injured group eliminated massive tissues and24patients in the intact group eliminated fragment or “patchy tissues”. Noserious adverse reactions and complications happened such as intrauterineadhesions, amenorrhea.2. After the treatment,31with intact endometrium and27with injuredendometrium. In the intact group the main type was type Ⅱ (25/31,80.65%), and in the injured group the main type was type Ⅰ (16/27,59.26%). The type combination between the two groups had statistical dif-ference (P＜0.05). In the injured group, the damaged diameter range from0.3cm to3.2cm, mean (1.4±0.7) cm.3. In all patients, the average NPV of fibroids was (58.62±59.80) cm3，and the average ablation rate was70.06±17.28%immediately after HIFUtreatment. Including obvious efficient51cases, efficient7cases and no ef-fect0case. Between the two groups the ablation rate had no statistical dif-ference (P＞0.05).4. At1,3,6months after the HIFU, the volume of the fibroids reducedfollowing with time. The average shrinkage of the volume was32.87±15.67%,50.60±18.52%,63.94±18.19%respectively. The fibroidvolume of the injured group reduced more than the intact group, the differ-ence had statistical value (P＜0.05).5. At the6months after HIFU treatment, the menstruation of the pa-tients including20come to normal,30reduce than before,8had no change. No one become severity. The injured group recovery better than the intactgroup, the difference had statistical value (P＜0.05).Conclusions:1. HIFU ablation submucosal fibroids is efficient. In the6months’follow-up, all fibroids volume reduced than the treatment before, and mostof the menstruation improved.2. HIFU treatment of the submucosal fibroids may lead to part endo-metrial lesions. The risk may be associated with the volume of fibroidsconvex to uterine cavity. Followed up for6months, vaginal discharge in-creased in a short period of time. It didn’t affect the patients’ quality of life.No serious adverse reaction and complications happened.3. Under the condition of no difference in fibroids ablation rate, thefibroids’ volume shrunk is more obvious, menstruation improve better inthe injured group. It may be associated with fibroids ruled out more easily.4. When patients with submucosal fibroids after HIFU treatment suf-fer recurrence or relapse. Once again choose HIFU treatment is feasible,safe and effective.