目的:探讨腹腔镜超声引导下子宫肌瘤射频消融术的临床疗效及安全性。材料和方法:33例2至7型有症状的子宫平滑肌瘤FIGO患者在CroixRousse大学医院中心(临终关怀会里昂)和里尔的Saint-VincentdePaul医院接受了腹腔镜超声引导下的射频消融,在2020年6月至2022年12月之间。通过盆腔MRI和Higham评分评估每个肌瘤的特征和症状,术前和6个月时的SSS和HRQL评分。结果:33例患者共治疗了54个肌瘤。我们观察到手术后6个月的体积显着减少,平均21毫升(55,97毫升对74,37毫升,95CI[7,13-34,88],p=0.001)。每个肌瘤的最大直径也显著减少,平均11,78mm(41,89vs52,06,IC95%[8,83-14,73],p<0,05)。我们注意到痛经的NRS平均下降2.79点(2,1对4,89,95CI[1,14-4,42],p<0,05)。月经过多也有改善的趋势,通过Higham评分进行评估。的确,70%的患者有月经过多。月经过多改善了108,3分,手术前的平均Higham评分为197,3,手术后为87,9(IC95%[47,9-168,8],p=0,001)。关于UFS-QOL评分:症状严重程度评分(SSS)平均下降33分,症状改善的证明(27,04vs60,89,95CI[22,92-43,39],p<0,001),HRQL评分平均增加20分,证明生活质量改善(65,57vs42,7,95CI[15,83-37,85],p<0,001)。没有严重不良事件的报告。结论:在法国关于射频消融的第一项研究中,我们确认其改善症状和生活质量的效率,但其他研究是强制性的,以确认该手术的安全性,特别是在希望怀孕的患者中。
OBJECTIVE: To assess clinical and radiological efficacy and safety of laparoscopic ultrasound-guided radiofrequency ablation of uterine leiomyomas.
METHODS: Thirty-three patients with symptomatic uterine leiomyomas FIGO type 2 to 7, have undergone a laparoscopic ultrasound-guided radiofrequency ablation at Croix Rousse University Hospital Center (Hospices civils de Lyon) and at Saint-Vincent de Paul Hospital in Lille, between June 2020 and December 2022. The characteristics of each myoma and the symptoms were assessed with pelvic MRI and with Higham score, SSS and HRQL scores preoperatively and at 6 months.
RESULTS: A total of 54 fibroids have been treated in 33 patients. We observed a significant decrease of the volume 6 months after the surgery, on average 21mL (55.97 vs. 74.37mL, 95% CI [7.13-34.88], P=0.001). The maximum diameter of each fibroid was also significantly reduced on average 11.78mm (41.89 vs. 52.06, 95% CI [8.83-14.73], P<0.05). We noticed a significant decrease of the NRS for dysmenorrhea on average 2.79 points (2.1 vs. 4.89, 95% CI [1.14-4.42], P<0.05). There was also a trend to improvement of menorrhagia, assess by Higham score. Indeed, 70.8% of the patients had menorrhagia. Menorrhagia was improved of 108,3 points with an average Higham score before surgery of 197.3 versus 87.9 after surgery (95% CI [47.9-168.8], P=0.001). Concerning UFS-QOL score: the symptom severity score (SSS) decreased on average 33 points, testifying of symptom improvement (27.04 vs. 60.89, 95% CI [22.92-43.39], P<0.001) and the HRQL score increased on average 20 points testifying quality of life improvement (65.57 vs. 42.7, 95% CI [15.83-37.85]. P<0.001). No severe adverse event has been reported.
CONCLUSIONS: In this first French study about radiofrequency ablation. We confirm its efficiency for improvement of symptoms and quality of life but other study is mandatory to confirm the safety of this procedure in particular in patients with a wish to conceive.