Uterine fibroids are a common gynecological condition with numerous treatment methods, and one of them is the emergence of the injection l ablation technique (coagulation knife) in recent years. Although minimally invasive modalities for the treatment of fibroids are a trend in the development of gynecology, it is worth paying attention to whether the coagulation knife is deficient as a treatment for fibroids and whether the resulting complications are acceptable. In this paper, we collected some patients who were transferred to hospitals for reoperation after failure of coagulation knife for uterine fibroids and analyzed the reasons for their failure as follows.
I. Data
1.1 From January 2000 to January 2006, 15 patients aged 37-53 years were admitted to our hospital after the failure of coagulation knife for uterine fibroids, with a median age of 45 years. The average time of finding fibroids was 2-3 years, the average size of fibroids was 5-6 cm, 3 cases were combined with dysmenorrhea, 8 cases were combined with heavy menstrual bleeding, and 1 case had irregular vaginal bleeding. None of the treated patients had fertility requirements.
1,2 Thirteen patients underwent total hysterectomy 1~2 years after coagulation knife with no significant improvement in clinical symptoms; one case had increased vaginal bleeding three days after coagulation knife and underwent segmental scraping for endometrial undifferentiated small cell carcinoma, and underwent extensive total hysterectomy two months later; one case underwent emergency perforated bowel loop resection due to serious complications, and underwent total hysterectomy one year later with no significant improvement in clinical symptoms. Hysterectomy was performed one year later because the clinical symptoms did not improve significantly. Details are as follows.
No change
or worsening
Myoma shrinkage
30% or more
Bleeding and improvement of dysmenorrhea
Myoma degeneration
pelvic adhesions
Intestinal perforation
7 cases
0 cases
1 case
3 cases
11 cases
1 case
1,3 The average cost of coagulation knife treatment was 3000~10000. average 8000 yuan.
II. Discussion
2, 1 High-frequency electric knife has been used in clinical practice for more than 70 years since 1920. It has undergone four generations of change from spark plug discharge – high power electron tube – high power transistor – high power MOS tube. Radiofrequency ablation instrument is based on high l electric knife, the high frequency oscillation current through radiofrequency temperature control treatment intervention into the myoma tissue, so that the myoma tissue produces biological effects and tissue coagulation, degeneration, necrosis, dissolution and finally absorbed and eliminated by the body, in order to achieve the purpose of treatment. From the original intention of the coagulation knife designers, it is true that the coagulation knife can treat uterine fibroids minimally invasively, but the size of the tissue focal domain, the high ll rate, the thermal sensitivity of the tissue, the thermal conductivity of the tissue and the blood flow rate together determine the extent of damage to the target tissue. The main parameters that determine the biological focal area are sound intensity, frequency, duration and frequency of irradiation, and the interval of irradiation. The size of the coagulative necrosis range is a very important parameter. In terms of tissue focal range, coagulation knife treatment of uterine fibroids is ideal when the fibroid is round and the interventional conductor is inserted exactly in the center of the fibroid circle. This allows for uniform coagulation of the entire fibroid.
2,2 Uterine fibroids are cured or effective, generally speaking, it is considered that: 1, the fibroids shrink more than 30%; 2, the symptoms improve significantly and do not affect work, study and life; 3, it is not life-threatening; 4, there are no serious complications; 5, it does not affect or less affect fertility. In this paper, 15 patients treated with coagulation knife had to undergo total hysterectomy due to the failure of coagulation knife treatment for various reasons mentioned above. 7 patients had no change in fibroids and clinical symptoms after coagulation knife treatment, among which 3 cases had degeneration of fibroids, 2 cases had enlargement of fibroids, and 2 cases had dysmenorrhea with increased menstrual bleeding. There was no myoma shrinkage of more than 30%, and 5 patients had myoma shrinkage of 10%-20% after treatment. The coagulation knife will be monitored by computer throughout the whole process of 4-8 superconducting needles with temperature difference electric couples, inserted into the myoma through the vagina, and the frequency of injection and treatment time are inputted into the instrument by the operator according to the size of the myoma, and it is difficult to show the coagulation and necrosis of the myoma at that time, and the data is inputted only by experience, and in order to reduce complications, some operators choose safe and low-dose energy, which results in incomplete coagulation of the myoma and promotes the degeneration of the myoma. Even some patients with myoma cells proliferated actively after electrical stimulation and grew instead of shrinking. This seems to be evidenced by the pathological report of active myoma cell growth after total hysterectomy in a patient with enlarged myoma in our group. The presence of dysmenorrhea with increased menstrual bleeding was related to the misdiagnosis of myxoma as leiomyosarcoma before treatment, which led to disruption of the normal contraction axis of the tumor and uterus due to “incomplete coagulation”, causing abnormal contraction or incomplete contraction of the uterus during menstruation, resulting in dysmenorrhea and increased menstrual bleeding. 2 patients with dysmenorrhea had pathology of myxoma after total hysterectomy.
2,3 In contrast, complications can occur if the patient is given too much “energy”. 11 patients were found to have varying degrees of pelvic adhesions during total hysterectomy, which were associated with reactive inflammation of the peri-uterine tissues with too much ejection. One patient had severe abdominal pain on the day of treatment, and intestinal perforation was found two days later by dissection, which was related to high “energy”.
2.4 One patient still underwent coagulation knife treatment because of irregular menstruation, ignoring the endometrial malignant disease and missed the diagnosis of endometrial cancer, which was a painful lesson.
2.5 The treatment cost of radiofrequency ablation technique is too high, averaging 8000 RMB, which is equal to laparoscopic stripping of myoma and two to three times of caesarean operation, and it is unknown whether the cost is proportional to the technical difficulty.
III. Summary
Radiofrequency ablation technique (coagulation knife) is theoretically feasible as a minimally invasive way to treat uterine fibroids. However, the frequency of RF, irradiation time and times, interval time, irradiation mode, and thermal sensitivity of tissues, thermal conductivity of tissues and blood flow rate together determine the damage range of target tissues, and it is difficult to combine various different types of influencing factors. There are no uniform norms and parameters, resulting in uneven treatment results. If the “energy” is not sufficient, the tumor will not be “ablated” or “ablation” will be incomplete; on the contrary, complications will occur. How to find the right point of “energy” needs to be accumulated by cases and gradually transition from experience to standard.