| Background:Diffuse uterine leiomyomatosis(DUL) is a rare and special type of uterine fibroids of female reproductive system. This disease have occurred all over the world, but low incidence, at present, we don’t know its causes and mechanisms. Owing to the large numbers of fibroids, the uterine volume often obviously increased, which often leads to menorrhagia, prolonged menstruation, frequent urination, constipation, menorrhea, miscarriage, infertility, anemia and other symptoms. This is also the reason why patients visit doctors. There are many therapies for diffuse uterine leiomyomatosis, including drug therapies, myomectomy, uterine artery embolization (UAE), and hysterectomy. High intensity focused ultrasound (HIFU) as a new non-invasive treatment method have been widely used in the treatment of uterine fibroids, however, most of the clinical studies are just for single and multiple uterine fibroids, there is no clinical study about HIFU in the treatment of DUL.Objective:To preliminary explore the safety and efficacy of HIFU in the treatment of DUL, providing reference for further study.Methods:1.To retrospectively analyze 20 patients with DUL who were treated by HIFU, to evaluate its safety through adverse reaction, treatment and recovery time.2. Each diameter of non-purfused volume was measured in the uterus through enhanced T1 MRI after treatment, by which to calculate the ablation volume. The uterine volume was measured by ultrasound at 3 and 6 month after HIFU treatment, in order to figure out the reduction rate of the uterus. To evaluate its efficacy by comparing the volume of uterine and clinical symptom scores before and after treatment.Results:1.20 patients were successfully treated by the treatment of HIFU, and main discomfort during the treatment were sacral pain, skin burning and treatment area pain, which could be tolerated. After the treatment, all of the adverse reactions were SIRA-B, no more serious side effects occured.2.The average ablation volume of the 20 patients were 279.63± 177.44(88.96-659.36)cm3, accounting for 32.35±3.74%(22.02-41.60%)of the volume of uterus.3.At 3 and 6 months after treatment 18 patients were followed up through ultrasound, comparing the uterine volume with the same ones before treatment, and the mean shrink rate were 24.87±5.08% (14.22-36.80%) and 28.38±6.77%(7.98-40.17)%. Before treatment, the mean uterine volume were 857.92±525.40(283.27-2170.13)cm3, and at 3 and 6 months after the treatment, the mean uterine volume were 679.85±379.60(263.74-1653.10)cm3,613.99±365.81(202.39-1545.37) cm3. Comparing the volume before and after treatment, the difference between them was statistically significant(P<0.05).4.The following-up of 20 patients were completed at 3 and 6 months after treatment. The clinical symptom scores were reduced by 6.05±2.91 (2-12) points and 7.60±3.52 (2-16) points. Before treatment the mean symptom scores were18.25±4.38(12-26)points, the symptom scores were 11.80±1.88(9-15)points,10.25±1.80(8-15)points at 3 and 6 months after treatment. The difference before and after treatment was statistically significant(P<0.05).Conclusions:It is safe and efficacy of HIFU ablation in the treatment of DUL, however, further study about long-term safety and efficacy of HIFU is still needed. |
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