The Efficacy Comparison of High-Intensity Focused Ultrasound Ablation and Surgical Excision in the Treatment of Abdominal Wall Endometriosis

doi:10.12280/gjfckx.20221063

Abstract

Abstract:

Objective: To compare the clinical effect of high-intensity focused ultrasound (HIFU) ablation and surgery in the treatment of abdominal wall endometriosis (AWE). Methods: The clinical data of 262 AWE patients hospitalized in Beijing Obstetrics and Gynecology Hospital, Capital Medical University from January 2015 to November 2019 were retrospectively analyzed. According to the treatment modality, the patients were divided into HIFU group (n=64) and surgery group (n=198), comparing the operation time, intraoperative bleeding, hospital stay, postoperative lesion size, pain level, clinical efficiency and complications. Results: The median operation time in the HIFU group was 34.5 (22.3, 47.3) min, which was significantly shorter than 40.0 (30.0, 60.0) min in the surgery group (Z=-3.112, P=0.002). The median hospital stay in the HIFU group was 2.0 (2.0, 3.0) days, which was shorter than 7.0 (6.0, 8.3) days in the surgery group (Z=-11.982, P=0.000). There was no significant difference in clinical efficiency between 2 groups (χ²=-1.207, P=0.227). In the HIFU group, ultrasound follow-up was performed 1, 3 and 6 months after treatment. The ablation rates were (88.25±13.09)%, (92.33±9.18)%, (98.67±4.09)%, respectively. By the 12th month after operation, the ablation rates were 100.00%. The volume of lesions before treatment was significantly different from that at 1, 3, 6 and 12 months after treatment (P<0.05). There was significant difference in the degree of periodic pain between the HIFU group and the surgery group at 3, 6 and 12 months after treatment (P<0.05). The rate of adverse reactions was 6.25% (4/64) in the HIFU group and 3.54% (7/198) in the surgery group, and there was no statistically significant difference between 2 groups (χ²=0.340, P=0.560). Conclusions: HIFU ablation for AWE is comparable to surgical resection, but it is superior to surgical resection in terms of shortening procedure time, reducing hospital stay and alleviating postoperative pain, making HIFU ablation one of the safe and effective options available to AWE patients.

Key words: Endometriosis, Abdominal wall, High-intensity focused ultrasound ablation, Recurrence, Comparative effectiveness research, Abdominal wall endometriosis

WANG Sha, DUAN Hua. The Efficacy Comparison of High-Intensity Focused Ultrasound Ablation and Surgical Excision in the Treatment of Abdominal Wall Endometriosis[J]. Journal of International Obstetrics and Gynecology, 2023, 50(3): 261-265.

Figures/Tables 3

References 25

[1]	Saunders P, Horne AW. Endometriosis: Etiology, pathobiology, and therapeutic prospects[J]. Cell, 2021, 184(11):2807-2824. doi: 10.1016/j.cell.2021.04.041. doi: 10.1016/j.cell.2021.04.041 pmid: 34048704
[2]	中国医师协会妇产科医师分会, 中华医学会妇产科学分会子宫内膜异位症协作组. 子宫内膜异位症诊治指南(第三版)[J]. 中华妇产科杂志, 2021, 56(12):812-824. doi: 10.3760/cma.j.cn112141-20211018-00603. doi: 10.3760/cma.j.cn112141-20211018-00603
[3]	Foley CE, Ayers PG, Lee TT. Abdominal Wall Endometriosis[J]. Obstet Gynecol Clin North Am, 2022, 49(2):369-380. doi: 10.1016/j.ogc.2022.02.013. doi: 10.1016/j.ogc.2022.02.013
[4]	Carsote M, Terzea DC, Valea A, et al. Abdominal wall endometriosis (a narrative review)[J]. Int J Med Sci, 2020, 17(4):536-542. doi: 10.7150/ijms.38679. doi: 10.7150/ijms.38679 pmid: 32174784
[5]	张文. 腹壁子宫内膜异位症诊断和治疗的研究进展[J]. 现代妇产科进展, 2019, 28(5):391-392. doi: 10.13283/j.cnki.xdfckjz.2019.05.017. doi: 10.13283/j.cnki.xdfckjz.2019.05.017
[6]	Luo S, Zhang C, Huang JP, et al. Ultrasound-guided high-intensity focused ultrasound treatment for abdominal wall endometriosis: a retrospective study[J]. BJOG, 2017, 124(Suppl 3):59-63. doi: 10.1111/1471-0528.14741. doi: 10.1111/1471-0528.14741
[7]	Lee JS, Kim YJ, Hong GY, et al. Abdominal wall endometriosis treatment by ultrasound-guided high-intensity focused ultrasound ablation: a case report[J]. Gynecol Endocrinol, 2019, 35(2):109-111. doi: 10.1080/09513590.2018.1490713. doi: 10.1080/09513590.2018.1490713
[8]	Shi S, Ni G, Ling L, et al. High-Intensity Focused Ultrasound in the Treatment of Abdominal Wall Endometriosis[J]. J Minim Invasive Gynecol, 2020, 27(3):704-711. doi: 10.1016/j.jmig.2019.06.012. doi: 10.1016/j.jmig.2019.06.012
[9]	Gachabayov M, Horta R, Afanasyev D, et al. Abdominal wall endometrioma: Our experience in Vladimir, Russia[J]. Niger Med J, 2016, 57(6):329-333. doi: 10.4103/0300-1652.193858. doi: 10.4103/0300-1652.193858
[10]	陈孝平, 汪建平, 赵继宗, 等. 外科学[M]. 9版. 北京: 人民卫生出版社, 2018:98.
[11]	中国医师协会妇产科医师分会子宫内膜异位症专业委员会, 中华医学会妇产科学分会子宫内膜异位症协作组. 子宫内膜异位症长期管理中国专家共识[J]. 中华妇产科杂志, 2018, 53(12):836-841. doi: 10.3760/cma.j.issn.0529-567x.2018.12.007. doi: 10.3760/cma.j.issn.0529-567x.2018.12.007
[12]	Rogers PA, Adamson GD, Al-Jefout M, et al. Research priorities for endometriosis[J]. Reprod Sci, 2017, 24(2):202-226. doi: 10.1177/1933719116654991. doi: 10.1177/1933719116654991 pmid: 27368878
[13]	Edwards K, Tsai SH, Kothari A. Clinical and imaging features of abdominal wall endometriomas[J]. Australas J Ultrasound Med, 2018, 21(1):24-28. doi: 10.1002/ajum.12076. doi: 10.1002/ajum.12076
[14]	Tajima S, Bito T, Ikeda T, et al. Cutaneous endometrial cancer arising from heterotopic endometriosis in an abdominal caesarean section scar[J]. J Eur Acad Dermatol Venereol, 2016, 30(4):683-685. doi: 10.1111/jdv.12964. doi: 10.1111/jdv.12964 pmid: 25622645
[15]	Min K, Han HH. Treatment of abdominal wall endometriosis using a mini-abdominoplasty design[J]. Arch Aesthetic Plast Surg, 2018, 24(3):134-137. doi: 10.14730/aaps.2018.24.3.134. doi: 10.14730/aaps.2018.24.3.134
[16]	Vaz-de-Macedo C, Gomes-da-Costa A, Mendes S, et al. Abdominal Wall Endometriosis Excision with Mesh Closure-Report of Two Cases[J]. Surg Technol Int, 2016, 28:196-201. pmid: 27042795
[17]	Marinova M, Huxold HC, Henseler J, et al. Clinical Effectiveness and Potential Survival Benefit of US-Guided High-Intensity Focused Ultrasound Therapy in Patients with Advanced-Stage Pancreatic Cancer[J]. Ultraschall Med, 2019, 40(5):625-637. doi: 10.1055/a-0591-3386. doi: 10.1055/a-0591-3386 pmid: 29665583
[18]	高强度聚焦超声肿瘤治疗系统临床应用指南(试行)[J]. 中华医学杂志, 2005, 85(12):796-797. doi: 10.3760/j:issn:0376-2491.2005.12.002. doi: 10.3760/j:issn:0376-2491.2005.12.002
[19]	Chen J, Chen W, Zhang L, et al. Safety of ultrasound-guided ultrasound ablation for uterine fibroids and adenomyosis: A review of 9988 cases[J]. Ultrason Sonochem, 2015, 27:671-676. doi: 10.1016/j.ultsonch.2015.05.031. doi: S1350-4177(15)00160-1 pmid: 26093678
[20]	Xiao-Ying Z, Ying-Shu G, Jiu-Mei C, et al. Effect of pre-treatment with gonadotropin-releasing hormone analogue GnRH-α on high-intensity focussed ultrasound ablation for diffuse adenomyosis: a preliminary study[J]. Int J Hyperthermia, 2018, 34(8):1289-1297. doi: 10.1080/02656736.2018.1440014. doi: 10.1080/02656736.2018.1440014
[21]	艾星子·艾里, 郭铮宇, 张晓霏. 子宫腺肌病高强度聚焦超声消融治疗研究进展[J]. 山东大学学报(医学版), 2022, 60(7):36-42. doi: 10.6040/j.issn.1671-7554.0.2022.0225. doi: 10.6040/j.issn.1671-7554.0.2022.0225
[22]	蔡鑫, 林振江, 汤亚兰, 等. 不同方法治疗腹壁子宫内膜异位症的临床疗效[J]. 中华妇幼临床医学杂志(电子版), 2020, 16(3):351-357. doi: 10.3877/cma.j.issn.1673-5250.2020.03.015. doi: 10.3877/cma.j.issn.1673-5250.2020.03.015
[23]	Xiao-Ying Z, Hua D, Jin-Juan W, et al. Clinical analysis of high-intensity focussed ultrasound ablation for abdominal wall endometriosis: a 4-year experience at a specialty gynecological institution[J]. Int J Hyperthermia, 2019, 36(1):87-94. doi: 10.1080/02656736.2018.1534276. doi: 10.1080/02656736.2018.1534276
[24]	Sacks D, McClenny TE, Cardella JF, et al. Society of Interventional Radiology clinical practice guidelines[J]. J VascInterv Radiol, 2003, 14(9):S199-S202. doi: 10.1097/01.RVI.0000094584.83406.3e. doi: 10.1097/01.RVI.0000094584.83406.3e
[25]	Wang Y, Wang W, Wang L, et al. Ultrasound-guided high-intensity focused ultrasound treatment for abdominal wall endometriosis: preliminary results[J]. Eur J Radiol, 2011, 79(1):56-59. doi: 10.1016/j.ejrad.2009.12.034. doi: 10.1016/j.ejrad.2009.12.034 pmid: 20116953

组别	n	年龄（岁）	BMI （kg/m²）	剖宫产史		月经周期		病灶直径（cm）	合并症*	病灶数量				与周围组织粘连
组别	n	年龄（岁）	BMI （kg/m²）	1次	2次	增殖期	分泌期	病灶直径（cm）	合并症*	1个	2个	3个	4个	脂肪组织	筋膜层	肌层	腹膜
手术组	198	34.2±4.5	22.9±3.5	163	35	100	98	2.2（1.7，2.9）	5	154	31	9	4	17	112	56	13
HIFU组	64	33.7±4.2	22.9±3.6	49	15	30	34	2.5（2.1，3.0）	3	55	7	1	1	8	35	15	6
t或χ²或Z		0.806	0.023	1.039		0.255		-1.888	0.208	2.327				1.752
P		0.421	0.982	0.308		0.614		0.059	0.648	0.507				0.625

组别	n	年龄（岁）	BMI （kg/m²）	剖宫产史		月经周期		病灶直径（cm）	合并症*	病灶数量				与周围组织粘连
组别	n	年龄（岁）	BMI （kg/m²）	1次	2次	增殖期	分泌期	病灶直径（cm）	合并症*	1个	2个	3个	4个	脂肪组织	筋膜层	肌层	腹膜
手术组	198	34.2±4.5	22.9±3.5	163	35	100	98	2.2（1.7，2.9）	5	154	31	9	4	17	112	56	13
HIFU组	64	33.7±4.2	22.9±3.6	49	15	30	34	2.5（2.1，3.0）	3	55	7	1	1	8	35	15	6
t或χ²或Z		0.806	0.023	1.039		0.255		-1.888	0.208	2.327				1.752
P		0.421	0.982	0.308		0.614		0.059	0.648	0.507				0.625

组别	n	手术时间（min）	住院时间（d）	临床疗效（例）
组别	n	手术时间（min）	住院时间（d）	完全缓解	临床有效	复发
手术组	198	40.0（30.0，60.0）	7.0（6.0，8.3）	170	21	7
HIFU组	64	34.5（22.3，47.3）	2.0（2.0，3.0）	51	9	4
Z或χ²		-3.112	-11.982		-1.207
P		0.002	0.000		0.227

组别	n	手术时间（min）	住院时间（d）	临床疗效（例）
组别	n	手术时间（min）	住院时间（d）	完全缓解	临床有效	复发
手术组	198	40.0（30.0，60.0）	7.0（6.0，8.3）	170	21	7
HIFU组	64	34.5（22.3，47.3）	2.0（2.0，3.0）	51	9	4
Z或χ²		-3.112	-11.982		-1.207
P		0.002	0.000		0.227

组别	n	术后1个月	术后3个月	术后6个月	术后12个月
手术组	198	3.0（1.0，4.0）	2.0（1.0，4.0）	2.0（1.0，3.0）	1.5（1.0，2.0）
HIFU组	64	2.0（0.0，4.0）	2.0（1.0，3.0）	1.0（0.0，3.0）	1.0（0.0，2.0）
Z		-35.580	-34.940	-33.850	-34.480
P		0.067	0.013	<0.001	0.003