Analysis Of Abdominal Wall Injury Factors Of High Intensity Focused Ultrasound Treatment For Uterine Fibroids

Background: Uterine fibroids are the most common benign tumor of female genital, which composed of smooth muscle cell proliferation and a small amount of fibrous connective tissue. Its exact pathogenesis is still unknown. Clinical symptoms of patients with uterine fibroids are related to its location and degeneration. Uterine fibroids can cause many clinical symptoms such as menstrual quantity increasing and menstrual cycle extending, lower abdominal mass, leucorrhea increasing and causing pressure on the bladder. It may also cause pain, infertility, abortion, etc. High Intensity Focused Ultrasound(HIFU), which uses focused ultrasound energy for therapeutic methods such as tissue ablation extracorporeally, is a new ultrasound technology. The efficacy and safety of the treatment has been widely recognized.With more clinical application of HIFU treatment on uterine fibroids, the incidence of treatment-related complications has decreased. But in the actual clinical application, due to the biological characteristics of focused ultrasound, there is still tissue damage. As the first station of ultrasonic channel, the abdominal wall is more likely to appear to be injured. How to reduce or even eliminate the incidence of abdominal wall injury effectively is of positive significance in clinic. So the abdominal wall injury factors of high intensity focused ultrasound treatment for uterine fibroids are still worth exploring.Objective: Found out the abdominal wall injury factors of high intensity focused ultrasound treatment for uterine fibroids with binary Logistic regression analysis.Materials and methods: A total of 228 patients would be analyzed which had less than 3 uterine fibroids and accepted HIFU treatment in the first affiliated hospital of Chongqing medical university between January 2015 and December 2015. Pelvic enhanced-MRI was performed before and the first day after the treatment. People who had the skin redness, swelling, blisters, fester, indurations and(or) high signal in front abdominal wall on T2W1 were considered to have abdominal wall injury. The possible factors,abdominal wall thickness, BMI, volume of fibroids, the distance of fibroids to the abdominal wall, irradiation time, the frequency, energy, size of water bag, abdominal wall scar, of abdominal wall injury would be analyzed with binary Logistic regression analysis.Results: 1. A total of 86(37.7%) patents suffered abdominal wall injury, included 2(0.9%) patients with skin redness and swelling, 1(0.4%) person with indurations underneath the skin, 83(36.4%) patients with high signal in front abdominal wall on T2W1 only. 2. Univariate logistic regression analysis showed that the abdominal wall thickness(P =0.001,OR=1.540,95%CI 1.198-1.981),BMI(P =0.000,OR=2.393,95%CI 1.514-3.782), irradiation time(P =0.000,OR=2.126,95%CI 1.6133-2.802), the frequency(P =0.015,OR=1.355,95%CI 1.060-1.732) and energy(P =0.000,OR=1.896,95%CI 1.454-2.473)were of statistical significance(P < 0.05). The distance of fibroids to the abdominal wall(P =0.068,OR=1.254,95%CI 0.983-1.598)could be connected with abdominal wall injury, 3. Multivariate logistic regression analysis showed that the abdominal wall thickness(P =0.004,OR=1.504,95%CI 1.136-1.990), the distance of fibroids to the abdominal wall(P =0.000,OR=1.994,95%CI 1.438-2.765) and irradiation time( P=0.000, OR=2.825, 95%CI 2.008-3.974)were statistically significant(P < 0.05).Conclusion: 1. The abdominal wall thickness, BMI, the distance of fibroids to the abdominal wall, irradiation time, the acoustic frequency and energy were correlated with abdominal wall injury of HIFU treatment for uterine fibroids. 2. The abdominal wall thickness, the distance of fibroids to the abdominal wall and irradiation time were the independent factors of abdominal wall injury caused by HIFU treatment for uterine fibroids.