Clinical Analysis Of High Intensity Focused Ultrasound In Treatment Of Abdominal Wall Endometriosis

Objective:To observe the clinical effectiveness of High Intensity Focused Ultrasound(HIFU)ablation in the treatment of Abdominal Wall Endometriosis(AWE)by comparing its clinical effect with that of surgical resection.Materials and Methods:The data of the hospitalized patient with diagnosis of AWE in Northwest Women and Children’s Hospital between February 1,2017 to January 31,2020 were retrospectively analyzed and treated with HIFU or surgical resection.According to the inclusion and exclusion criteria,46 AWE patients who underwent HIFU ablation were collected.50patients with AWE who received surgical resection treatment during the same period were collected according to their age,height,Body Mass Index(BMI),lesion diameter,lesion volume,Visual Analogue Scale(VAS),pregnancy and delivery order,lesion number,and onset incubation period.Retrospectively analyze the clinical data of the two groups and summarize the clinical characteristics.The clinical effectiveness of HIFU in the treatment of AWE was investigated by comparing postoperative pain relief,VAS score,operation time,length of hospital stay and postoperative hospitalization cost,the postoperative complications and recurrence of patients in the two groups.At the same time,the changes of the lesions before and after HIFU treatment were observed,and the influencing factors of the volume of the lesions after HIFU were analyzed.Results:1.Clinical characteristics:There were 96 patients in this study,among which 91patients(94.79%)had abdominal wall pain with menstrual periodicity,5 patients(5.21%)showed intermittent pain,82 patients(85.42%)had single lesion,39 patients’lesions(40.63%)were located on the right side of cesarean section incision,and 73 patients(76.04%)had mass tenderness.2.Basic information of the two groups of patients:There were no significant differences between the two groups in age,height,BMI,lesion diameter,lesion volume,preoperative VAS score,gestational order,delivery order,lesion number and incubation period(P>0.05).3.Comparison of postoperative pain relief rates between the two groups:The pain complete relief rates of the HIFU group at 1,3,6 and 12 months after surgery were63.04%,71.34%,80.43%and 97.83%,respectively,and those of the surgery group were78.00%,88.00%,96.00%and 96.00%,respectively.There was no significant difference in the total effective rate of pain relief between the two groups at 1,3,6 and 12 months after treatment(P>0.05).Follow-up ranged from 1 to 4 years postoperatively,the recurrence rate of HIFU group(4.35%)was similar to that of operation group(4.00%)and there was no significant difference(P>0.05).4.Comparison of postoperative VAS scores between the two groups:The VAS scores of the two groups of patients after surgery were significantly lower than those before surgery,the VAS scores of the HIFU group(0.44±0.26、0.37±0.22、0.25±0.20)at 1,3,and 6 months after surgery were significantly lower than those of the surgery group(0.83±0.28、0.56±0.35、0.47±0.44),and there were differences statistical significance(P<0.05).There was no significant difference in VAS scores between the two groups at 12 months after surgery(X~2=0.007,P=0.932).5.Changes of lesions before and after HIFU treatment:The volume of AWE lesions at 1,3,6 and 12 months after surgery was significantly reduced from(5.64±2.24)cm~3before surgery to(2.56±1.42)cm~3,(0.87±0.54)cm~3,(0.25±0.16)cm~3,(0.13±0.08)cm~3after surgery.The mean volume reduction rates at 1,3,6 and 12 months respectively were 54.61%,84.57%,95.57%and 97.69%.There were significant differences in the volume of the lesions in different postoperative follow-up time between groups(P<0.05).6.Comparison of time cost and hospitalization cost between the two groups:The duration of operation,total days of hospitalization and postoperative days of hospitalization in the HIFU group were significantly shorter than those in the surgery group,with statistical significance(P<0.05).The average hospitalization cost of HIFU ablation was higher than that of the surgery group(P<0.05).7.Postoperative complications in the two groups:There were 2 cases(4.34%)of postoperative complications in the HIFU group,according to the classification of society of interventional radiology(SIR),both of which were SIR-A.In the operation group,postoperative complications occurred in 4 cases(8.00%),including 3 cases of SIR-A grade and 1 case of SIR-B grade.There was no significant difference in the total incidence of complications between the two groups(X~2=0.100,P=0.752).8.Analysis of influencing factors of lesion volume change after HIFU:Binary Logistic regression analysis showed that the effect of lesion involvement(OR=1.60,95%CI:1.17～2.54)and ablation rate(OR=1.81,95%CI:1.09～2.64)on postoperative volume change of HIFU was statistically different(P<0.05).There was no significant difference in age,BMI,number of cesarean sections,number of lesions,onset latency,postoperative combination of drugs and preoperative VAS score(P>0.05).Conclusions:1.High intensity focused ultrasound(HIFU)is effective for the treatment of abdominal wall endometriosis(AWE).The volume of the lesion gradually decreases after ablation,and the pain symptoms are significantly alleviated.2.HIFU treatment of AWE has the same effect as surgical resection,and HIFU has the advantages of no blood loss,low postoperative pain score,mild complications,and short postoperative recovery time,providing patients with a new treatment option.3.The ablation rate and the level of lesion involvement are the influencing factors for volume reduction after HIFU.Therefore,the increase of the ablation rate during the operation may be a key factor in the reduction of the AWE lesion after the operation.