Efficacy and safety of ultrasound ablation for uterine fibroids in patients with abdominal surgical scars on the acoustic pathway.

Abstract

Objective: To investigate the safety and efficacy of ultrasound-guided high-intensity focused ultrasound (USgHIFU) ablation for uterine fibroids in patients with abdominal wall scars on the acoustic pathway.

Methods: A total of 608 patients were included in the retrospective analysis. Preoperative and postoperative pelvic MRI data, treatment data, and follow-up information were collected. Patients were divided into scar group (213 cases: 172 transverse and 41 longitudinal abdominal wall scars) and non-scar group (395 cases). Treatment efficacy, adverse events, and complications were compared between groups.

Results: The median fibroid ablation rates were similar in the scar and non-scar groups: 87.81% (IQR 78.20-98.80%) and 87.67% (IQR 75.18-96.75%), respectively (p = 0.403). The incidence of skin-burning sensation during operation in the scar group was significantly higher than that in the non-scar group [15.96% (34/213) vs 8.35% (33/395), p = 0.004]. Postoperative abdominal wall MRT2WI signal changes occurred in 22.37% (136/608) of cases, mainly in the subcutaneous fat layer (50%, 68/136), appearing as patchy mixed high signal on MRT2WI. These changes were higher in the scar group than in the non-scar group [28.17% (60/213) vs 19.24% (76/395), p = 0.012]. However, these abnormalities resolved spontaneously without intervention. No serious adverse events or complications occurred in either group during or after treatment.

Conclusion: Abdominal wall surgical scars on the acoustic pathway do not significantly affect the safety and efficacy of USgHIFU for uterine fibroids.