| BackgroundUterine myoma is the most common benign tumor of female genital organs,which 20%-50% clinical symptoms appear.In the past,many patients would choose open uterine fibroids resection or even total hysterectomy,to the majority of women,which brought great physical and psychological trauma.With the improvement of the quality of life,more and more patients require to retain the uterus by invasive or noninvasive treatment.High intensity focused ultrasound ablation(HIFU)is a new noninvasive method for the treatment of solid tumors,it has a significant clinical effect,less trauma,less adverse reactions and other significant advantages.But clinical studies have shown that HIFU is not ideal for larger uterine fibroids(5-7cm diameter),may be the focal region is small,for larger volume of myoma,the lack of overlap between the focal region and the focal region is easily caused,resulting in a decrease in the ablation rate;in addition,there are plenty of blood vessels in larger fibroids,it is easy to take away the heat generated by the focus and reduce the ablation rate in the treatment process.And many studies have shown that mifepristone can significantly reduce the volume of fibroids,but it has the high relapse rate after stopping,and the large adverse reactions of long-term use.This study is to allow patients take small doses of mifepristone before treatment,and then use HIFU to help treatment,with a view to greatly improve the complete ablation rate of HIFU.ObjectiveThis study combined mifepristone with HIFU to treat the larger uterine fibroids,observing the reduction degree of uterine myoma and to analyze its therapeutic effect.MethodsSelecting of 96 cases of married patients with uterine fibroids in in First Affiliated Hospital of Xinxiang Medical College from February 2014 to February 2015,all patients were diagnosed by clinical symptoms,signs,ultrasound results in line with the diagnosis of uterine fibroids.The average diameter of the uterine fibroids was about 5-7cm.Treatment methods and procedures,prospective efficacy and possible complications were explained in detail before treatment,all patients signed our hospital informed consent.The patients were divided into mifepristone group,mifepristone combined with HIFU group and HIFU group according to different treatment methods.Patients in the mifepristone group were treated with low dose of oral mifepristone for 3 months,and then withdraw,patients in the mifepristone combined with HIFU group were treated with low dose of oral mifepristone for 3 months before HIFU treatment,HIFU group was treated with pure HIFU.The clinical manifestations of the three groups were basically the same,and there was no statistical significance.All patients after 3 and 6 months came to our hospital outpatient after the end of treatment,for color Doppler ultrasound examination,and asked whether the patient symptoms improve or not.Results1)uterine volume: The volume of uterus in the mifepristone group was 134.9±19.3cm3,the mifepristone combined with HIFU group was 133.1±19.1cm3,and the HIFU group was 130.1 + 18.0cm3,there was no significant difference in the uterine volume between the the mifepristone group and the mifepristone combined with HIFU group before treatment(P > 0.05),they are comparable.And there was also no significant difference in the uterine volume between the mifepristone combined with HIFU group and HIFU group before treatment(P > 0.05),they are comparable.The mifepristone group did not do any treatment after take mifepristone 3 months,after withdrawal of 3 and 6 months,the uterine volume was respectively about 64.3±23.6cm3、104.1±32.1cm3,the uterine volume of the mifepristone combined with HIFU group after 3 and 6 months treatment of HIFU was respectively about 37.7±23.6cm3、25.3±27.6cm3,and the uterine volume of the HIFU group was about 80.5 + 27.3cm3 、69.2 + 30.2cm3.The mifepristone group and the mifepristone combined with HIFU group of uterine volume were treated with t test after 3、6 months teratment,the mifepristone combined with HIFU group was lower than the mifepristone group,the results were P < 0.01,the difference was statistically significant.The HIFU group and the mifepristone combined with HIFU group of uterine volume were treated with t test after 3、6 months teratment,the mifepristone combined with HIFU group was lower than the HIFU group,the results were P < 0.01,the difference was statistically significant.2)the reduction rate of uterine fibroids: After 3 、6 months of treatment,the shrinkage rate of the mifepristone combined with HIFU group was respectively(73 + 13.2)%、(82.3 + 15.4)%,of the mifepristone group the reduction rate of myoma volume was respectively(54.0±19.3)% 、(23.5±17.9)%,of the HIFU group the reduction rate of myoma volume was respectively(39 + 14.1)%,(47.9 + 16.9)%.The mifepristone group and the mifepristone combined with HIFU group of the reduction rate of uterine fibroids were treated with t test after 3、6 months teratment,the mifepristone combined with HIFU group was higher than the mifepristone group,the results were P < 0.01,the difference was statistically significant.The HIFU group and the mifepristone combined with HIFU group of the reduction rate of uterine fibroids were treated with t test after 3、6 months teratment,the mifepristone combined with HIFU group was higher than the HIFU group,the results were P < 0.01,the difference was statistically significant..3)efficacy analysis: The mifepristone combined with HIFU group after the treatment,26 cases of markedly effective,effective in 5 cases,ineffective in 1 cases,in the HIFU group after treatment,0 cases were markedly effective,27 cases were effective,and 5 cases were ineffective,in the mifepristone group after treatment,0 cases were markedly effective,18 cases were effective,and 14 cases were ineffective.Three sets of data were treated with chi square test,the results was P < 0.01,the difference was statistically significant.ConclusionsMifepristone combined with HIFU treatment of larger uterine fibroids can significantly reduce the volume of fibroids,improve the reduction ratio of fibroid,and the clinical effect is significant.As a treatment modality for women with larger uterine fibroids to retain the uterus,the combination of HIFU and mifepristone is a better choice. |
PDF Full Text Request