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Published on: March 7, 2011
Percutaneous Sclerotherapy Followed by Transabdominal Microwave Ablation for Treatment of Uterine Fibroids: A
Hui-Li Zhang1, Yu Yao1, Jia-Xin Li1
1Department of Medical Ultrasound, Shanghai Tenth People's Hospital, School of Medicine, Tongji University, Shanghai, China; Shanghai Engineering Research Center of Ultrasound Diagnosis and Treatment, Shanghai, China.
Purpose:
To evaluate the clinical and technical effectiveness, treatment efficiency, and safety of ultrasound (US)-guided polidocanol sclerotherapy combined with transabdominal microwave ablation (MWA) for fibroids.
Materials And Methods:
Fifty-seven patients with 74 fibroids who underwent sclerotherapy combined with MWA treatment were included. Intraoperative contrast-enhanced US was used to assess sclerotherapy-induced vascular occlusion. Fibroid characteristics and ablation parameters were compared based on the vascular occlusion degrees (Grades 0-3). The nonperfusion volume ratio (NPVr) was calculated from magnetic resonance (MR) imaging. Follow-up at 3, 6, and 12 months evaluated symptom relief, uterine/fibroid volume, hemoglobin (Hb) level, pictorial blood loss assessment chart (PBAC) score, symptom severity score (SSS), and health-related quality of life (HRQOL) scores. Adverse events (AEs) were recorded.
Results:
The mean patient age was 42 years (interquartile range [IQR], 38-46 years). Complete, significant, slight, and failed occlusion rates were 48.6%, 39.2%, 6.8%, and 5.4%, respectively. The degree of occlusion was associated with fibroid classification, T2 signal intensity, and NPVr. Median NPVr was 98.5% (IQR, 88.3%-101.1%), and median ablation efficiency was 4.9 s/cm (IQR, 3.3-6.4 s/cm). At 12 months, the complete relief rates of menorrhagia, prolonged menses, anemia, frequent micturition, and pelvic discomfort were 76.9%, 66.7%, 71.4%, 61.9%, and 68.8%, respectively. Uterine and fibroid volume decreased significantly, with improvement in Hb levels, PBAC, SSS, and HRQOL scores. No moderate or worse AEs occurred.
Conclusions:
US-guided sclerotherapy followed by MWA appears to be a practical, efficient, and safe treatment for fibroids.
