BACKGROUND: One of the modern methods of organ-saving non-invasive remote treatment of uterine fibroids is ablation of myomatous nodes with high-intensity focused ultrasound (HIFU).
AIM: The aim of this study was to analyze changes in the parameters of ultrasonic ablation when using intraoperative control with the help of an ultrasound contrast agent.
MATERIALS AND METHODS: In the period from 2016 to 2018, a total of 208 patients with symptomatic uterine myoma underwent HIFU ablation of myomatous nodes. The two groups of patients were compared: group I included 98 patients aged 36 to 52 years (mean age: 44.39 7.12 years) with intraoperative control with an ultrasound contrast agent (sulfur hexafluoride); group II consisted of 110 patients aged 20 to 55 years (mean age: 38.33 8.72 years), whose treatment was not controlled by the contrast agent.
RESULTS: Using the Mann-Whitney test, we obtained statistically significant differences in the following parameters: the duration of ultrasound ablation was 215.28 70.57 min (from 70 to 390 min) in group I, and 610.84 56.26 min (from 290 to 1230 min) in group II (p 0.005); the average energy was 329.06 33.06 W in group I, and 293.68 64.51 W in group II (p 0.001); good tolerance of the operation was shown in 91% of cases in group I, and in 61.8% of cases in group II; satisfactory tolerance of the operation was shown in 7.7% of cases in group I, and in 37.3% of cases in group II (p 0.001).
CONCLUSIONS: The data obtained indicate that the performance of HIFU ablation with the use of an ultrasonic contrast agent allowed halving the insonation time, while using submaximal and maximum ultrasound exposure powers with better tolerance of intervention by patients.
BACKGROUND: Uterine fibroids are a benign tumor found in two out of three women of reproductive age. The most modern methods of organ preserving treatment of uterine fibroids are uterine artery embolization, which is a minimally invasive procedure, and high intensity focused ultrasound (HIFU) ablation, which is a non-invasive procedure. According to the literature and our own experience, uterine artery embolization is ineffective in 17.1% of cases and HIFU ablation in 16% of cases, mainly due to the peculiarities of blood supply to myomatous nodes.
AIM: The aim of this study was to compare the effectiveness of the treatment of uterine fibroids using an isolated HIFU ablation technique and combined sequential application of selective embolization of uterine artery supplying the myomatous node and HIFU ablation.
MATERIALS AND METHODS: This study included two groups of patients with symptomatic uterine fibroids. Group 1 consisted of 133 patients treated using the isolated HIFU ablation, and group 2 comprised 90 patients treated sequentially using supplying the myomatous node and HIFU ablation. Age and clinical manifestations of the disease (menometrorrhagia, pain syndrome, impaired function of adjacent organs, anemia) did not differ in the both groups.
RESULTS: The following parameters were different in the study groups: the duration of ultrasound ablation (p 0.005) and the decrease in the volume of myomatous nodes in one, six and 12 months after surgery (p 0.001). The duration of ultrasound ablation was 610.84 (56.26) minutes in group 1 and 215.28 (70.57) minutes in group 2. In group 1, the decrease in the volume of myomatous nodes was 12.2% in one month and 58.97% in 12 months after surgery, compared to the initial value. In group 2, the decrease was 42.9% and 67.5%, respectively.
CONCLUSIONS: The combined treatment of uterine fibroids using supplying the myomatous node and FUVI ablation techniques allowed for reducing the duration of the FUVI ablation operation three times and the volume of the node by 67.5% within one year compared to group 1 (58.97%).
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