| PurposeTo evaluate the clinical efficacy and complications of ultrasound-guided percutaneous microwave ablation therapy for symptomatic uterine fibroids and adenomyosis in a prospective multicenter study.Materials and MethodsPatients with symptomatic uterine fibroids or adenomyosis who underwent PMWA at multiple treatment centers in China between January 2013 and October 2015 were prospectively studied. After ablation, ablation rate of the myomas was calculated to assess the ablation effect. The fibroids or uterine volume, hemoglobin level, UFS-QOL (uterine fibroid symptom and health-related quality of life questionnaire) scores and dysmenorrhea degree of patients with adenomyosis were recorded before and at 3,6, 12and 24 months after ablation to evaluate the clinical efficacy. Any adverse reactions and complications were recorded during and after therapy.Results1. PMWA for uterine fibroids:A total of 348 patients (410 leiomyomas) from 9 treatment centers underwent the treatment (age,21-55 years; mean ± SD,39.7 ± 7.4 years). The mean diameter of the myomas was 2.00-12.50 cm (mean,4.92 ± 1.72 cm). The mean ablation rate of fibroids was (85.43 ± 14.40)%(51.77%-100%). The fibroids volume, hemoglobin level, SSS and HRQL scores were significantly improved compared with the condition before treatment, and the differences were statistically significant (P<0.05). The mean myoma reduction rate was 62.5%,78.0%,87.5% and 90.8% at 3,6,12 and 24 months after treatment, respectively. All patients successfully completed the ablation process and did not appear any discomfort. After ablation, sarcoid discharges from the vagina occurred in 23 patients. The main adverse reactions of patients were pain, vaginal secretion and fever. Most patients recovered in a short period of time without any treatment.2. PMWA for adenomyosis:A total of 470 patients from 8 treatment centers underwent the treatment. The age of the patients was 24 to 54 years (mean,39.6±5.2 years). The uterine volume was 57.88-1405.47 cm3 (mean,292.42± 194.93 cm3). The uterine volume, hemoglobin level, dysmenorrhea degree, SSS and HRQL scores were significantly improved compared with the condition before treatment, and the differences were statistically significant (P<0.05). The mean reduction rate of uterine volume was 45.2%,50.24%,54.12% and 48.43% at 3,6,12 and 24 months after treatment, respectively. The adverse reactions of patients were pain, vaginal secretion and fever. Besides, pelvic infection occurred in four patients. All patients recovered after anti-inflammation treatment. Gastrointestinal perforation occurred in three patients, and then the patient underwent partial small bowel resection and anastomosis. For another patient, elevated serum creatinine appeared on the second day after therapy. After symptomatic treatment, creatinine values returned to normal on the fourth day.ConclusionPMWA therapy is effective, convenient, and minimally invasive for FIGO (Federation International of Gynecology and Obstetrics) 1-6 uterine fibroids and adenomyosis. It has the added advantage of quick recovery and significant improvement of the patient’s quality of life. It’s especially suitable for young patients wish to retain the uterus. The adverse reactions and complications are less and mild. Serious complications could be avoided if we strictly grasp the indications, contraindications and treatment principles. PMWA therapy could be used as one of the minimally invasive treatment of uterine myoma and adenomyosis. |
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