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.	王丽萍, 柳弘彦, 杨林萍, 等. 86 例子宫肌瘤高强度聚焦超声消融治疗临床疗效的分析. 第三军医大学学报, 2013, 35(24): 2712-2714.
11.	张绪凤, 邓忠云, 李勇刚, 等. 高强度超声聚焦治疗子宫肌瘤 147 例临床观察. 淮海医药, 2012, 30(3): 232-233.
12.	沈忠兵, 朱向明, 倪观太, 等. 高强度聚焦超声消融治疗子宫肌瘤的临床评价. 皖南医学院学报, 2014, 33(6): 543-545.
13.	柯庆华, 周世琼, 陈朝晖, 等. 高强度聚焦超声治疗 72 例子宫肌瘤临床分析. 中华临床医师杂志(电子版), 2007, 1(3): 62-64.
14.	黄颖芬, 欧阳旺, 邹婷, 等. 高强度聚焦超声治疗子宫肌瘤 60 例近期疗效观察. 中国医药导报, 2011, 8(20): 245-246.
15.	侯海静, 叶玲玲, 姜雯. 高强度聚焦超声治疗子宫肌瘤 74 例临床分析. 中国妇幼保健, 2006, 14: 1938-1939.
16.	胡景, 张树生. 高强度聚焦超声治疗子宫肌瘤 135 例临床疗效观察. 中国内镜杂志, 2009, 15(11): 1179-1180.
17.	曾飚, 周敏, 华媛媛, 等. 高强度聚焦超声治疗子宫肌瘤的安全性分析. 重庆医学, 2013, 42(4): 370-372.
18.	徐涛, 秦秀朵, 周雯. 高强度聚焦超声治疗子宫肌瘤的并发症及处理. 西南军医, 2012, 14(1): 26-27.
19.	陶萌. 高强度聚焦超声治疗子宫肌瘤的初步观察. 中外妇儿健康, 2011, 19(5): 39-40.
20.	金玲利, 张蓉, 华淑静, 等. 高强度聚焦超声治疗子宫肌瘤的疗效观察. 中国计划生育学杂志, 2012, 20(5): 352-353.
21.	董世阔, 李彦芳. 高强度聚焦超声治疗子宫肌瘤的临床分析. 吉林医学, 2010, 31(34): 6226-6228.
22.	朱文群, 谭可, 李尚富. 高强度聚焦超声治疗子宫肌瘤疗效观察. 中国现代医学杂志, 2008, 18(6): 754-756.
23.	黄晓云, 李富梅, 王虹, 等. 高强度聚焦超声治疗子宫肌瘤临床研究. 中国实用医药, 2009, 4(2): 90-91.
24.	段廷旺, 蒲怀智, 雷小林. 高强度聚焦超声治疗子宫小肌瘤疗效分析. 四川医学, 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.	赵敬生, 党蓉芳, 孙平, 等. 预防高强度聚焦超声治疗并发症的操作技巧. 吉林医学, 2013, 34(26): 5404-5406.
39.	孙海燕, 陈红香, 黄淑华, 等. 高强度聚焦超声治疗子宫肌瘤疗效研究. 中国超声医学杂志, 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. 王丽萍, 柳弘彦, 杨林萍, 等. 86 例子宫肌瘤高强度聚焦超声消融治疗临床疗效的分析. 第三军医大学学报, 2013, 35(24): 2712-2714.
11. 张绪凤, 邓忠云, 李勇刚, 等. 高强度超声聚焦治疗子宫肌瘤 147 例临床观察. 淮海医药, 2012, 30(3): 232-233.
12. 沈忠兵, 朱向明, 倪观太, 等. 高强度聚焦超声消融治疗子宫肌瘤的临床评价. 皖南医学院学报, 2014, 33(6): 543-545.
13. 柯庆华, 周世琼, 陈朝晖, 等. 高强度聚焦超声治疗 72 例子宫肌瘤临床分析. 中华临床医师杂志(电子版), 2007, 1(3): 62-64.
14. 黄颖芬, 欧阳旺, 邹婷, 等. 高强度聚焦超声治疗子宫肌瘤 60 例近期疗效观察. 中国医药导报, 2011, 8(20): 245-246.
15. 侯海静, 叶玲玲, 姜雯. 高强度聚焦超声治疗子宫肌瘤 74 例临床分析. 中国妇幼保健, 2006, 14: 1938-1939.
16. 胡景, 张树生. 高强度聚焦超声治疗子宫肌瘤 135 例临床疗效观察. 中国内镜杂志, 2009, 15(11): 1179-1180.
17. 曾飚, 周敏, 华媛媛, 等. 高强度聚焦超声治疗子宫肌瘤的安全性分析. 重庆医学, 2013, 42(4): 370-372.
18. 徐涛, 秦秀朵, 周雯. 高强度聚焦超声治疗子宫肌瘤的并发症及处理. 西南军医, 2012, 14(1): 26-27.
19. 陶萌. 高强度聚焦超声治疗子宫肌瘤的初步观察. 中外妇儿健康, 2011, 19(5): 39-40.
20. 金玲利, 张蓉, 华淑静, 等. 高强度聚焦超声治疗子宫肌瘤的疗效观察. 中国计划生育学杂志, 2012, 20(5): 352-353.
21. 董世阔, 李彦芳. 高强度聚焦超声治疗子宫肌瘤的临床分析. 吉林医学, 2010, 31(34): 6226-6228.
22. 朱文群, 谭可, 李尚富. 高强度聚焦超声治疗子宫肌瘤疗效观察. 中国现代医学杂志, 2008, 18(6): 754-756.
23. 黄晓云, 李富梅, 王虹, 等. 高强度聚焦超声治疗子宫肌瘤临床研究. 中国实用医药, 2009, 4(2): 90-91.
24. 段廷旺, 蒲怀智, 雷小林. 高强度聚焦超声治疗子宫小肌瘤疗效分析. 四川医学, 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. 赵敬生, 党蓉芳, 孙平, 等. 预防高强度聚焦超声治疗并发症的操作技巧. 吉林医学, 2013, 34(26): 5404-5406.
39. 孙海燕, 陈红香, 黄淑华, 等. 高强度聚焦超声治疗子宫肌瘤疗效研究. 中国超声医学杂志, 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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