A Preliminary Study On Safety And Short-time Efficacy Of Ultrasound-guided Microwave Ablation For Uterine Fibroid

ObjectiveUltrasound-guided microwave ablation of uterine fibroids(UMWAUF)is a real-time ultrasound-guided implantation of microwave radiators into the tumor,heated and solidified to achieve precise in-situ inactivation.This study analyzed the safety and short-term efficacy of UMWAUF,and provided basis for the clinical application of UMWAUF.Materials and MethodsInclusion cases and follow-up:A total of 58 patients receiving UMWAUF in our hospital from January 2017 to December 2018 were collected,with a total of 77 fibroids.Detailed records of inpatient medical records and follow-up data were obtained at 1,3,6 and 12 months after surgery.Microwave ablation methods:Ultrasound guided percutaneous and unarmed puncture was used.If the puncture failed to reach the target position for 3 times,the uterine device was performed.Intraoperative ultrasound real-time monitoring of the thermal field range,when strong echo coverage of the entire tumor stopped ablation.Safety evaluationUMWAUF safety was evaluated by Clavien-Dindo surgical complication grading system according to the severity of postoperative complications and corresponding treatment.Grade ?:Fever,mild pain,gastrointestinal discomfort,vaginal discharge,etc.Level ?:Adverse reactions are more severe and require blood transfusion and total parenteral nutrition.Level ?:surgical intervention is required for injuries of the bladder,intestine,ureter,large blood vessels and other important organs.Level ?:severe life-threatening injuries.Level ?:death.Effectiveness evaluationIt includes two parts:intraoperative evaluation of fibroid ablation and postoperative clinical evaluation.Intraoperative evaluation of fibroid ablation effect:The ablation rate was used as the evaluation index.The ablation rate=(volume of non-perfusion area after ablation/total volume of fibroids before ablation)*100%.Complete ablation:ablation rate>80%,most ablation:ablation rate 60%- 79%,partial ablation:ablation rate 20%-59%,invalid:ablation rate<19%.Clinical efficacyThe reduction rate of fibroids(FSR),UFS-QOL which including symptom severity score(SSS)and health-related quality of life score(HROL),and Hb improvement in anemia patients at 1,3,6,and 12 months postoperatively were taken as clinical efficacy indicators,and FSR as the main evaluation index.The curative effect was very significant:FSR>50%;Hb was? 3 g/L higher than before;SSS and HRQL changes?50%before treatment.Significant:30%<FSR?49%;Hb was higher than before(? 2.9 g/L,? 2 g/L);Changes in SSS and HRQL values? 30%,? 49%before treatment.Effective:10%<FSR<29%;Hb 1 g/L higher than before;Changes in SSS and HRQL values were ?29%,?10%before treatment.Invalid:FSR<10%;Hb is unchanged or lower than before;UFS-QOL was unchanged or lower than before treatment.ResultsGeneral condition:All the 58 patients(77 fibroids)had UMWAUF,and the ablation process was smooth,The success rate of all anterior wall and submucosal fibroids unarmed puncture was 100%(52/52,4/4),the success rate of posterior wall fibroids unarmed puncture was 28.57%(6/21).The success rate of puncture which posterior wall fibroids with puncture failure was 100%(15/15)by assisted vaginal lifting device.Results of postoperative follow-up:58 cases with 77 fibroids were followed up at 1 and 3 months after surgery,24 cases with 30 fibroids were followed up at 6 months after surgery,and 8 cases with 9 fibroids were followed up at 12 months after surgery.Safety evaluationClavien-Dindo complications within 72h after surgery were mainly grade I.Among them,91.38%(53/58)had mild pain in the lower abdomen;77.59%(45/58)of mild nausea,31.03%(18/58)of postoperative fever,did not deal with it.The complications were mainly grade I after 1 month follow-up,and 82.76%(48/58)had some vaginal discharge.No grade? or above complications occurred.Efficacy evaluationEffect of intraoperative fibroid ablation:The complete fibroid ablation rate was 97.40%(75/77),most of the ablation rate was 2.60%(2/77).Partial ablation and no response were 0%(0/77).Clinical effects at 1,3,6,12 months after surgery1 month after surgery:very significant efficacy:0%(0/77),significant:1.30%(1/77),effective:10.39%(8/77),ineffective:88.31%(68/77).3 months after surgery,very significant efficacy:81.82%(63/77),significant:16.88%(13/77),effective:1.30%(1/77),ineffective:0%(0/77).6 months after surgery,very significant efficacy:100%(30/30)significant,effective and ineffective:0%(0/30).12 months after surgery,very significant efficacy:100%(9/9),significant,effective and ineffective:0%(0/9).ConclusionsUMWAUF is a safe,accurate and minimally invasive interventional technique for the treatment of gynecological benign tumors.The UMWAUF ablation effect is ideal,the short-term clinical effect is firm and definite,and the long-term effect needs further follow-up.Transvaginal uterine lift can adjust the position of the uterus and fix the uterus to facilitate puncture,and at the same time keep the uterus away from the intestinal tube to improve the success rate of puncture and the safety of ablation,which can be used as one of the auxiliary methods for UMWAUF.