Clinical complications of high-intensity focused ultrasound for uterine fibroids: a meta-analysis of single rate_Chinese Journal of Evidence-Based Medicine

Authors：

WU Pingyong ,  CHEN Wenwei , HU Wei , CHEN Liao , HUANG Xingyue , HUANG Xin

Department of Ultrasound, Renmin Hospital of Wuhan University, Wuhan, 200433, P.R.China;

Corresponding?author：

CHEN Wenwei, Email: pingyong71@163.com

Keywords：

High-intensity focused ultrasound; Uterine fibroids; Complications; Meta-analysis

DOI：

10.7507/1672-2531.201606084

Video：

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Objective To analysis the safety of high-intensity focused ultrasound (HIFU) in the treatment of uterine fibroids and provide references for clinical practice and prevention of complications of gynecological diseases. Methods Databases including PubMed, The Cochrane Library (Issue 2, 2016), EMbase, CBM, CNKI, and VIP were searched to collect studies concerning the complications of HIFU for uterine fibroids from March 1^st 2005 to February 15^th 2016. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies. Then, meta-analysis was performed by using R software. Results A total of twenty studies involving 2 405 patients were included. The results of meta-analysis showed that complications rate of gynecological system induced by HIFU was 6.63% (95%CI 3.58% to 12.28%); among them, the incidence of vaginal bleeding was 5.82% (95%CI 3.22% to 10.53%), and the incidence of abdominal pain was 10.02% (95%CI 4.77% to 21.05%). Conclusion The current evidence shows that there is a certain amount of complications of HIFU for uterine fibroids. Due to the limited quantity and quality of included studies, the above results are needed to be validated by more studies.

Citation： WU Pingyong, CHEN Wenwei, HU Wei, CHEN Liao, HUANG Xingyue, HUANG Xin. Clinical complications of high-intensity focused ultrasound for uterine fibroids: a meta-analysis of single rate. Chinese Journal of Evidence-Based Medicine, 2017, 17(3): 312-319. doi: 10.7507/1672-2531.201606084 Copy

1.	?Stewart EA. Uterine fibroids. Lancet, 2001, 357: 293-298.
2.	Fedele L, Parazzini F, Luchini L,et al. Recurrence of fibroid myomectomy: a transvaginal ultrasono-graphic study. Hum Reprod, 1995, 10(7): 1795-1796.
3.	Zhou YF. High intensity focused ultrasound in clinical tumor ablation. World J Clin Oncol, 2011, 2(1): 8-27.
4.	Dobrotwir A, Pun E. Clinical 24 month experience of the first MrgFUS unit for treatment of uterine fibroids in Australia. J Med Imaging Radiat Oncol, 2012, 56(4): 409-416.
5.	Higgins JPT, Green S(editors). Cochrane Handbook for Systematic Reviews of Interventions Versions 5.0.1 [updated March 2011]. The Cochrane Collaborations. Available at: .
6.	Slim K, Nini E, Forestier D,et al. Methodological index for nonrandomized studies (minors): development and validation of a new instrument. ANZ J Surg, 2003, 73(9): 712-716.
7.	Chongsuvivatwong V. Analysis of epidemiological data using R and Epicalc. Epidemiology Unit Prince of Songkla University. Thailand, 2008.
8.	Freeman MF, Tukey JW. Transformations related to the angular and the square root. Ann Math Statist, 1950, 21(4): 607-611.
9.	Ford AC, Marwaha A, Lim A,et al. Systematic review and meta-analysis of the prevalence of irritable bowel syndrome in individuals with dyspepsia. Clin Gastroenterol Hepatol, 2010, 8(5): 401-409.
10.	王麗萍, 柳弘彥, 楊林萍, 等. 86 例子宮肌瘤高強度聚焦超聲消融治療臨床療效的分析. 第三軍醫大學學報, 2013, 35(24): 2712-2714.
11.	張緒鳳, 鄧忠云, 李勇剛, 等. 高強度超聲聚焦治療子宮肌瘤 147 例臨床觀察. 淮海醫藥, 2012, 30(3): 232-233.
12.	沈忠兵, 朱向明, 倪觀太, 等. 高強度聚焦超聲消融治療子宮肌瘤的臨床評價. 皖南醫學院學報, 2014, 33(6): 543-545.
13.	柯慶華, 周世瓊, 陳朝暉, 等. 高強度聚焦超聲治療 72 例子宮肌瘤臨床分析. 中華臨床醫師雜志(電子版), 2007, 1(3): 62-64.
14.	黃穎芬, 歐陽旺, 鄒婷, 等. 高強度聚焦超聲治療子宮肌瘤 60 例近期療效觀察. 中國醫藥導報, 2011, 8(20): 245-246.
15.	侯海靜, 葉玲玲, 姜雯. 高強度聚焦超聲治療子宮肌瘤 74 例臨床分析. 中國婦幼保健, 2006, 14: 1938-1939.
16.	胡景, 張樹生. 高強度聚焦超聲治療子宮肌瘤 135 例臨床療效觀察. 中國內鏡雜志, 2009, 15(11): 1179-1180.
17.	曾飚, 周敏, 華媛媛, 等. 高強度聚焦超聲治療子宮肌瘤的安全性分析. 重慶醫學, 2013, 42(4): 370-372.
18.	徐濤, 秦秀朵, 周雯. 高強度聚焦超聲治療子宮肌瘤的并發癥及處理. 西南軍醫, 2012, 14(1): 26-27.
19.	陶萌. 高強度聚焦超聲治療子宮肌瘤的初步觀察. 中外婦兒健康, 2011, 19(5): 39-40.
20.	金玲利, 張蓉, 華淑靜, 等. 高強度聚焦超聲治療子宮肌瘤的療效觀察. 中國計劃生育學雜志, 2012, 20(5): 352-353.
21.	董世闊, 李彥芳. 高強度聚焦超聲治療子宮肌瘤的臨床分析. 吉林醫學, 2010, 31(34): 6226-6228.
22.	朱文群, 譚可, 李尚富. 高強度聚焦超聲治療子宮肌瘤療效觀察. 中國現代醫學雜志, 2008, 18(6): 754-756.
23.	黃曉云, 李富梅, 王虹, 等. 高強度聚焦超聲治療子宮肌瘤臨床研究. 中國實用醫藥, 2009, 4(2): 90-91.
24.	段廷旺, 蒲懷智, 雷小林. 高強度聚焦超聲治療子宮小肌瘤療效分析. 四川醫學, 2012, 33(4): 703-704.
25.	Jiang N, Xie B, Zhang X, He M,et al. Enhancing ablation effects of a microbubble-enhancing contrast agent ("SonoVue") in the treatment of uterine fibroids with high-intensity focused ultrasound: a randomized controlled trial. Cardiovasc Intervent Radiol, 2014, 37(5): 1321-1328.
26.	Voogt MJ, Trillaud H, Kim YS,et al. Volumetric feedback ablation of uterine fibroids using magnetic resonance-guided high intensity focused ultrasound therapy. Eur Radiol, 2012, 22(2): 411-417.
27.	Kim YS, Kim JH, Rhim H,et al. Volumetric MR-guided high-intensity focused ultrasound ablation with a one-layer strategy to treat large uterine fibroids: initial clinical outcomes. Radiology, 2012, 263(2): 600-609.
28.	Mindjuk I, Trumm CG, Herzog P,et al. MRI predictors of clinical success in MR-guided focused ultrasound (MRgFUS) treatments of uterine fibroids: results from a single centre. Eur Radiol, 2015, 25(5): 1317-1328.
29.	Orsi F, Monfardini L, Bonomo G,et al. Ultrasound guided high intensity focused ultrasound (USgHIFU) ablation for uterine fibroids: Do we need the microbubbles? Int J Hyperthermia, 2015, 31(3): 233-239.
30.	Ouldamer L, Marret H. Therapeutic alternatives of uterine fibroids except medicinal treatment and embolization. J Gynecol Obstet Biol Reprod (Paris), 2011, 40(8): 928-936.
31.	Humphrey VF. Ultrasound and matter-physical interactions. Prog Biophys Mol Biol, 2007, 93(1-3): 195-211.
32.	Tempany CM, Stewart EA, Mc Dannold N,et al. MR imaging -guided focused ultrasound surgery of uterine leiomyomas a feasibility study. Radiology, 2003, 226(3): 897-905.
33.	Zderic V, Keshavarzi A, Noble ML,et al. Hemorrhage control in arteries using high - intensity focused ultrasound: a survival study. Ultrasonics, 2006, 44(1): 46-53.
34.	Stewart EA, Gedroyc WM, Tempany CM,et al. Focused ultrasound treatment of uterine fibroid tumors: safety and feasibility of a noninvasive thermoablative technique. Am J Obstet Gynecol, 2003, 189(1): 48-54.
35.	Kim HS, Baik JH, Pham LD,et al. MR-guided high-intensity focused ultra-sound treatment for symptomatic uterine leiomyomata: long-term outcomes. Acad Radiol, 2011, 18(8): 970-976.
36.	Stewart EA, Gostout B, Rabinovici J,et al. Sustained relief of leiomyoma symptoms by using focused ultrasound surgery. Obstet Gynecol, 2007, 110(2 Pt 1): 279-287.
37.	Sun HY, Huang SH, Wang W,et al. Analysis of the efficacy of high intensity focused ultrasound in the treatment of 142 cases of adenomyosis (12 cases of pregnancy). Prog Biophys MolBiol, 2013, 13(27): 5348-5352.
38.	趙敬生, 黨蓉芳, 孫平, 等. 預防高強度聚焦超聲治療并發癥的操作技巧. 吉林醫學, 2013, 34(26): 5404-5406.
39.	孫海燕, 陳紅香, 黃淑華, 等. 高強度聚焦超聲治療子宮肌瘤療效研究. 中國超聲醫學雜志, 2007, 23(11): 877.
40.	Yutaka M, Sawako T, Hiromi H,et al. Decreasing margins to the uterine serosa as a method for increasing the volume of fibroids ablated with magnetic resonance-guided focused ultrasound surgery. Eur J Obstet Gynecol Reprod Biol, 2009, 146(1): 92-95.
41.	Zhang L, Chen WZ, Liu YJ,et al. Feasibility of magnetic resonance imaging-guided high intensity focused ultrasound therapy for ablating uterine fibroids in patients with bowel lies anterior to uterus. Eur J Radiol, 2010, 73(2): 396-403.

1. ?Stewart EA. Uterine fibroids. Lancet, 2001, 357: 293-298.
2. Fedele L, Parazzini F, Luchini L,et al. Recurrence of fibroid myomectomy: a transvaginal ultrasono-graphic study. Hum Reprod, 1995, 10(7): 1795-1796.
3. Zhou YF. High intensity focused ultrasound in clinical tumor ablation. World J Clin Oncol, 2011, 2(1): 8-27.
4. Dobrotwir A, Pun E. Clinical 24 month experience of the first MrgFUS unit for treatment of uterine fibroids in Australia. J Med Imaging Radiat Oncol, 2012, 56(4): 409-416.
5. Higgins JPT, Green S(editors). Cochrane Handbook for Systematic Reviews of Interventions Versions 5.0.1 [updated March 2011]. The Cochrane Collaborations. Available at: .
6. Slim K, Nini E, Forestier D,et al. Methodological index for nonrandomized studies (minors): development and validation of a new instrument. ANZ J Surg, 2003, 73(9): 712-716.
7. Chongsuvivatwong V. Analysis of epidemiological data using R and Epicalc. Epidemiology Unit Prince of Songkla University. Thailand, 2008.
8. Freeman MF, Tukey JW. Transformations related to the angular and the square root. Ann Math Statist, 1950, 21(4): 607-611.
9. Ford AC, Marwaha A, Lim A,et al. Systematic review and meta-analysis of the prevalence of irritable bowel syndrome in individuals with dyspepsia. Clin Gastroenterol Hepatol, 2010, 8(5): 401-409.
10. 王麗萍, 柳弘彥, 楊林萍, 等. 86 例子宮肌瘤高強度聚焦超聲消融治療臨床療效的分析. 第三軍醫大學學報, 2013, 35(24): 2712-2714.
11. 張緒鳳, 鄧忠云, 李勇剛, 等. 高強度超聲聚焦治療子宮肌瘤 147 例臨床觀察. 淮海醫藥, 2012, 30(3): 232-233.
12. 沈忠兵, 朱向明, 倪觀太, 等. 高強度聚焦超聲消融治療子宮肌瘤的臨床評價. 皖南醫學院學報, 2014, 33(6): 543-545.
13. 柯慶華, 周世瓊, 陳朝暉, 等. 高強度聚焦超聲治療 72 例子宮肌瘤臨床分析. 中華臨床醫師雜志(電子版), 2007, 1(3): 62-64.
14. 黃穎芬, 歐陽旺, 鄒婷, 等. 高強度聚焦超聲治療子宮肌瘤 60 例近期療效觀察. 中國醫藥導報, 2011, 8(20): 245-246.
15. 侯海靜, 葉玲玲, 姜雯. 高強度聚焦超聲治療子宮肌瘤 74 例臨床分析. 中國婦幼保健, 2006, 14: 1938-1939.
16. 胡景, 張樹生. 高強度聚焦超聲治療子宮肌瘤 135 例臨床療效觀察. 中國內鏡雜志, 2009, 15(11): 1179-1180.
17. 曾飚, 周敏, 華媛媛, 等. 高強度聚焦超聲治療子宮肌瘤的安全性分析. 重慶醫學, 2013, 42(4): 370-372.
18. 徐濤, 秦秀朵, 周雯. 高強度聚焦超聲治療子宮肌瘤的并發癥及處理. 西南軍醫, 2012, 14(1): 26-27.
19. 陶萌. 高強度聚焦超聲治療子宮肌瘤的初步觀察. 中外婦兒健康, 2011, 19(5): 39-40.
20. 金玲利, 張蓉, 華淑靜, 等. 高強度聚焦超聲治療子宮肌瘤的療效觀察. 中國計劃生育學雜志, 2012, 20(5): 352-353.
21. 董世闊, 李彥芳. 高強度聚焦超聲治療子宮肌瘤的臨床分析. 吉林醫學, 2010, 31(34): 6226-6228.
22. 朱文群, 譚可, 李尚富. 高強度聚焦超聲治療子宮肌瘤療效觀察. 中國現代醫學雜志, 2008, 18(6): 754-756.
23. 黃曉云, 李富梅, 王虹, 等. 高強度聚焦超聲治療子宮肌瘤臨床研究. 中國實用醫藥, 2009, 4(2): 90-91.
24. 段廷旺, 蒲懷智, 雷小林. 高強度聚焦超聲治療子宮小肌瘤療效分析. 四川醫學, 2012, 33(4): 703-704.
25. Jiang N, Xie B, Zhang X, He M,et al. Enhancing ablation effects of a microbubble-enhancing contrast agent ("SonoVue") in the treatment of uterine fibroids with high-intensity focused ultrasound: a randomized controlled trial. Cardiovasc Intervent Radiol, 2014, 37(5): 1321-1328.
26. Voogt MJ, Trillaud H, Kim YS,et al. Volumetric feedback ablation of uterine fibroids using magnetic resonance-guided high intensity focused ultrasound therapy. Eur Radiol, 2012, 22(2): 411-417.
27. Kim YS, Kim JH, Rhim H,et al. Volumetric MR-guided high-intensity focused ultrasound ablation with a one-layer strategy to treat large uterine fibroids: initial clinical outcomes. Radiology, 2012, 263(2): 600-609.
28. Mindjuk I, Trumm CG, Herzog P,et al. MRI predictors of clinical success in MR-guided focused ultrasound (MRgFUS) treatments of uterine fibroids: results from a single centre. Eur Radiol, 2015, 25(5): 1317-1328.
29. Orsi F, Monfardini L, Bonomo G,et al. Ultrasound guided high intensity focused ultrasound (USgHIFU) ablation for uterine fibroids: Do we need the microbubbles? Int J Hyperthermia, 2015, 31(3): 233-239.
30. Ouldamer L, Marret H. Therapeutic alternatives of uterine fibroids except medicinal treatment and embolization. J Gynecol Obstet Biol Reprod (Paris), 2011, 40(8): 928-936.
31. Humphrey VF. Ultrasound and matter-physical interactions. Prog Biophys Mol Biol, 2007, 93(1-3): 195-211.
32. Tempany CM, Stewart EA, Mc Dannold N,et al. MR imaging -guided focused ultrasound surgery of uterine leiomyomas a feasibility study. Radiology, 2003, 226(3): 897-905.
33. Zderic V, Keshavarzi A, Noble ML,et al. Hemorrhage control in arteries using high - intensity focused ultrasound: a survival study. Ultrasonics, 2006, 44(1): 46-53.
34. Stewart EA, Gedroyc WM, Tempany CM,et al. Focused ultrasound treatment of uterine fibroid tumors: safety and feasibility of a noninvasive thermoablative technique. Am J Obstet Gynecol, 2003, 189(1): 48-54.
35. Kim HS, Baik JH, Pham LD,et al. MR-guided high-intensity focused ultra-sound treatment for symptomatic uterine leiomyomata: long-term outcomes. Acad Radiol, 2011, 18(8): 970-976.
36. Stewart EA, Gostout B, Rabinovici J,et al. Sustained relief of leiomyoma symptoms by using focused ultrasound surgery. Obstet Gynecol, 2007, 110(2 Pt 1): 279-287.
37. Sun HY, Huang SH, Wang W,et al. Analysis of the efficacy of high intensity focused ultrasound in the treatment of 142 cases of adenomyosis (12 cases of pregnancy). Prog Biophys MolBiol, 2013, 13(27): 5348-5352.
38. 趙敬生, 黨蓉芳, 孫平, 等. 預防高強度聚焦超聲治療并發癥的操作技巧. 吉林醫學, 2013, 34(26): 5404-5406.
39. 孫海燕, 陳紅香, 黃淑華, 等. 高強度聚焦超聲治療子宮肌瘤療效研究. 中國超聲醫學雜志, 2007, 23(11): 877.
40. Yutaka M, Sawako T, Hiromi H,et al. Decreasing margins to the uterine serosa as a method for increasing the volume of fibroids ablated with magnetic resonance-guided focused ultrasound surgery. Eur J Obstet Gynecol Reprod Biol, 2009, 146(1): 92-95.
41. Zhang L, Chen WZ, Liu YJ,et al. Feasibility of magnetic resonance imaging-guided high intensity focused ultrasound therapy for ablating uterine fibroids in patients with bowel lies anterior to uterus. Eur J Radiol, 2010, 73(2): 396-403.

Chinese Journal of Evidence-Based Medicine

Clinical complications of high-intensity focused ultrasound for uterine fibroids: a meta-analysis of single rate

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