Application of high intensity focused ultrasound in the treatment of uterine fibroids in overweight/obese women

Application of high intensity focused ultrasound in the treatment of uterine fibroids in overweight/obese women | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Application of high intensity focused ultrasound in the treatment of uterine fibroids in overweight/obese women Lijing Wu, Liying Zhong, Qingyan Zheng, Lingna Huang, Fengning Lin, and 2 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-6080873/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 22 May, 2025 Read the published version in BMC Women's Health → Version 1 posted 9 You are reading this latest preprint version Abstract Objective To investigate the clinical efficacy and safety of High-Intensity Focused Ultrasound (HIFU) in the treatment of uterine fibroids in overweight/obese women. Methods A retrospective analysis was conducted on the clinical data of 155 overweight/obese women with uterine fibroids treated at our hospital between January 2022 and January 2024. Among them, 75 patients underwent HIFU treatment (observation group), while 80 patients received conventional laparoscopic myomectomy (control group). Perioperative indicators, symptom improvement (assessed by the Symptom Severity Score, SSS), health-related quality of life (HRQL score), complications, and recurrence rates at 1-year post-treatment were compared between the two groups. Results All procedures were successfully completed in both groups. No significant differences were observed in baseline characteristics such as age, BMI, number of fibroids, maximum fibroid diameter, and hemoglobin levels between the two groups (P > 0.05). At 6 months and 1 year post-treatment, the observation group showed significantly better SSS scores (12.61 ± 1.22 vs. 15.89 ± 1.21; 10.40 ± 1.27 vs. 12.03 ± 1.33) and HRQL scores (89.35 ± 1.90 vs. 84.69 ± 1.24; 94.19 ± 1.16 vs. 91.69 ± 1.32) compared to the control group (P < 0.05). The total complication rate in the observation group was significantly lower than that in the control group (9.33% vs. 21.3%, χ² = 4.34, P = 0.04). No recurrence or fibroid enlargement was observed in the observation group at 1-year follow-up. Conclusion HIFU is an effective and safe treatment for uterine fibroids in overweight/obese women, offering advantages such as minimal invasiveness, fewer complications, and faster recovery. It represents a superior minimally invasive option for this patient population. High-Intensity Focused Ultrasound Uterine Fibroids Overweight Obesity Women Figures Figure 1 Introduction Uterine fibroids are the most common benign tumors of the female reproductive system, particularly prevalent among middle-aged women [ 1 ]. In line with international guidelines and the latest evidence, treatment options for uterine fibroids include pharmacological therapy, minimally invasive procedures, and traditional surgical approaches. Pharmacological therapy mainly involves the use of gonadotropin-releasing hormone agonists (GnRH-a) to shrink the size of fibroids, thereby alleviating symptoms and preparing patients for surgery [ 2 ]. Minimally invasive procedures, such as uterine artery embolization (UAE) and radiofrequency ablation (RFA), are also evolving. These techniques relieve symptoms by reducing the blood supply to fibroids or directly destroying fibroid tissue [ 3 ]. With societal development and lifestyle changes, the global prevalence of overweight and obesity has been steadily increasing [ 4 ], which not only elevates the risk of uterine fibroids [ 5 ], but also impacts the selection and efficacy of treatment methods. Traditional treatments, such as laparoscopic myomectomy, are effective but are associated with higher surgical risks, longer recovery periods, and potential adverse effects on fertility in overweight/obese patients [ 6 ]. In recent years, High-Intensity Focused Ultrasound (HIFU) has emerged as a promising non-invasive therapeutic technology for uterine fibroids [ 7 – 9 ]. HIFU focuses low-energy ultrasound waves from outside the body onto a target area within the body, creating a high-energy focal point. At this focal point, the energy of the ultrasound waves is converted into thermal energy, which rapidly increases the local tissue temperature and causes coagulative necrosis of the fibroid tissue. This thermal effect can precisely destroy the fibroid tissue while having minimal impact on surrounding normal tissues. This approach offers advantages such as being incision-free, bloodless, and enabling rapid recovery [ 10 – 12 ]. However, there is limited research on the efficacy and safety of HIFU specifically for overweight/obese populations. This study aims to compare the outcomes of HIFU and laparoscopic myomectomy in the treatment of uterine fibroids in overweight/obese women. Materials and methods Study Design This study is a retrospective analysis of clinical data from patients with uterine fibroids treated at our hospital between January 2022 and January 2024. The study compares the outcomes of High-Intensity Focused Ultrasound (HIFU) treatment and conventional laparoscopic myomectomy in overweight/obese women. Selection Criteria Patients were included if they met the following criteria: Diagnosis of uterine fibroids confirmed by clinical and imaging criteria; Categorized according to the International Federation of Gynecology and Obstetrics (FIGO) classification; Premenopausal women aged 18 years or older; Body Mass Index (BMI) calculated as weight (kg) divided by height squared (m²), with overweight defined as 24 kg/m² ≤ BMI < 28 kg/m² and obesity defined as BMI ≥ 28 kg/m², according to the Chinese Health Industry Standard "Criteria for Weight Assessment in Adults" (WS/T 428-2013); Non-pedunculated intramural/serosal fibroids (FIGO classification types 2-5), Maximum fibroid diameter between 2 cm and 10 cm, with the number of fibroids ranging from 1 to 5; No plans for pregnancy within the next 6 months. Exclusion criteria included: Severe comorbidities or systemic dysfunction affecting major organs. Submucosal pedunculated fibroids. Patients with clinical or imaging findings suggestive of malignant lesions of the uterus or adnexa were excluded. Specific criteria included: Ultrasound findings: Irregular borders, heterogeneous echogenicity, cystic areas, and necrosis within the fibroid. MRI findings: High T2 signal intensity with hemorrhagic and necrotic changes, central non-enhancement on contrast-enhanced MRI, and apparent diffusion coefficient (ADC) values indicative of malignancy. Biochemical markers: Elevated serum lactate dehydrogenase (LDH) levels, particularly when combined with MRI findings. Clinical presentation: Postmenopausal women with uterine fibroids and no history of hormone replacement therapy, presenting with abnormal uterine bleeding or rapid tumor growth. Study Outcomes The outcomes assessed were perioperative indicators, symptom improvement (assessed by the Symptom Severity Score, SSS), health-related quality of life (HRQL score)[13-16], complications, and recurrence rates at 1-year post-treatment. Ethical Statement The retrospective medical review was approved by the institutional review board (IRB) of the Fujian Maternity and Child Health Hospital,.And the study was performed in accordance with the principles stated in the Declaration of Helsinki. All patients underwent a detailed pre-treatment evaluation to rule out malignancy, including clinical assessment, ultrasound, MRI, and biochemical marker testing. Written informed consent was obtained from all participating patients.All patients were managed with standard of care, and their spouses or authorized representatives were thoroughly informed about the surgical procedure, associated risks, and potential complications before the surgery.All patient privacy information is protected. Data Collection Data were collected retrospectively from the medical records of 155 overweight/obese women with uterine fibroids. The data included age, BMI, number of fibroids, maximum fibroid diameter, preoperative hemoglobin levels, and postoperative outcomes. The HIFU treatment group (n=75) and the laparoscopic myomectomy group (n=80) were compared. Surgical Techniques HIFU Treatment: Preoperative preparations included bowel preparation, routine skin preparation, and urinary catheterization. The treatment area was degreased and degassed. Patients were positioned supine on the treatment table, and intravenous access was established. Pre-treatment scanning was performed to localize the fibroids, followed by sedation and analgesia as needed. Contrast-enhanced ultrasound was used to visualize blood flow signals in the target area and define the treatment range. The HIFU probe was activated with the following parameters configured: pulse duration of 0.02–0.08 seconds, interval time of 0.01–0.08 seconds, 10 pulses per treatment, and a treatment power of 300–340 watts. Parameters were adjusted based on the lesion characteristics. Treatment was terminated when a significant grayscale change was observed in the target area. Post-treatment contrast-enhanced ultrasound was performed to confirm the absence of blood flow signals, indicating effective treatment. Intraoperative fluid management was maintained, and the urinary catheter was removed postoperatively, with patients advised to rest in bed. Patients were advised to refrain from attempting pregnancy for at least 6 months following the procedure to allow for adequate healing and monitoring of potential complications. Laparoscopic Myomectomy: Preoperative preparations included bowel preparation, routine skin preparation, and urinary catheterization. Under general anesthesia, patients were placed in the lithotomy position, and a pneumoperitoneum was established. Pitocin was injected into the uterine body, and the fibroids were bluntly dissected and removed for pathological examination. The fibroid cavity and seromuscular layer were sutured intermittently with absorbable sutures. The laparoscopic suture technique used in this study was standardized, employing 2-0 Vicryl sutures for all procedures. Postoperative care followed standard protocols. All surgeries were performed by the same experienced surgical team to ensure consistency in surgical technique. For the control group, conventional laparoscopic myomectomy was performed using a standardized approach. The laparoscopic suture technique involved the use of 2-0 Vicryl sutures for intermittent suturing of the fibroid cavity and seromuscular layer. The study was approved by the Startup Fund for scientific research, Fujian Medical University (Approval No: 2021QH1197) Statistical analysis Statistical analysis was conducted using SPSS 22.0 statistical software. For continuous data, the Shapiro-Wilk test was employed to assess normality. If the Shapiro-Wilk test yielded a p-value > 0.05, the data were considered to follow a normal distribution; otherwise, the data were deemed non-normally distributed. For normally distributed data, results were expressed as mean ± standard deviation (x±s), and between-group comparisons were performed using independent sample t-tests. For non-normally distributed data, results were expressed as median (Q1, Q3), and between-group comparisons were conducted using the Mann-Whitney U test. Categorical data were presented as percentages (%), and between-group comparisons were carried out using the chi-square test. A p-value < 0.05 was considered statistically significant. Results Based on their preferences, 75 patients underwent HIFU treatment, designated as the Observation Group (OG), while 80 patients received conventional laparoscopic myomectomy, designated as the Control Group (CG). In the OG, 49 patients were overweight, and 26 were obese. In the CG, 52 patients were overweight, and 28 were obese. Data collected from both groups included age, Body Mass Index (BMI), number of fibroids, maximum fibroid diameter, and preoperative hemoglobin (Hb) levels. Comparative analysis showed no significant differences in baseline characteristics between the two groups (P > 0.05), indicating comparability (Table 1). A typical case is shown in Figure 1. Table 1. Baseline Patient Characteristics Group (n) OG(n=75) CG (n=80) t/χ2 P Age(year) 37.51 ± 5.82 38.48 ± 4.90 -1.12 0.263 overweight(count) 49（65.33%） 52（65%） 0.002 0.965 BMI(kg/m2) 27.11 ± 1.94 27.10 ± 1.85 0.02 0.982 Number of fibroids (count) 2.37 ± 0.98 2.42 ± 0.96 -0.33 0.742 Maximum diameter of uterine fibroid (cm) 4.86 ± 1.96 4.75 ± 1.86 0.35 0.730 Hb value of preoperative (g/L) 96.75 ± 6.38 96.53 ± 6.24 0.22 0.827 OG,Observation Group ; CG,Control Group; BMI,Body Mass Index; Hb,Hemoglobin Both the observation group and the control group successfully completed the surgeries. Before treatment, there was no significant difference in the Symptom Severity Score (SSS) between the two groups, with no statistical significance observed (P > 0.05). At 6 months and 1 year post-treatment, the SSS in the observation group was significantly lower than that in the control group. Meanwhile, the Health-Related Quality of Life (HRQL) subscale scores in the observation group were significantly higher than those in the control group, with statistical significance (P < 0.05). These results are comparable between the two groups.(Table 2). Table 2 SSS scores of two groups pre- and postoperation(mean±SD, score) Group (n) OG(n=75) CG (n=80) t P Preoperative 30.03±1.73 29.56±1.47 1.80 0.074 Six months postoperatively 12.61±1.22 15.89±1.21 -16.77 0.000 One year postoperatively 10.40±1.27 12.03±1.33 -7.76 0.000 OG,Observation Group ; CG,Control Group Before treatment, there was no significant difference in the Health-Related Quality of Life (HRQL) scores between the two groups, with no statistical significance observed (P > 0.05). At 6 months and 1 year post-treatment, the HRQL subscale scores in the observation group were significantly higher than those in the control group, with statistical significance (P < 0.05). These results are comparable between the two groups. (Table 3). Table3 HRQL scores of two groups pre- and postoperation(mean±SD, score) Group (n) OG(n=75) CG (n=80) t P Preoperative 81.95±1.38 81.75±1.59 0.82 0.414 Six months postoperatively 89.35±1.90 84.69±1.24 18.20 0.000 One year postoperatively 94.19±1.16 91.69±1.32 12.51 0.000 OG,Observation Group ; CG,Control Group Postoperative complications were compared between the two groups. The observation group had a lower total incidence of postoperative complications than the control group, with a statistically significant difference (P < 0.05). (Table 4). Both groups were followed up for 1 year postoperatively, and no recurrence or further enlargement of uterine fibroids was observed in either group. Table 4 Comparison of postoperative complications between the two groups [n(%)] Group (n) OG(n=75) CG (n=80) c2 P Postoperative Fever 5 7 0.24 0.628 Vaginal Bleeding 2 5 1.15 0.283 Postoperative Intestinal Obstruction 0 3 - - Readmission 0 2 - - Total Occurrence 7(9.33) 17(21.3) 4.20 0.040 OG,Observation Group ; CG,Control Group Discussion Uterine leiomyomas are the most common benign tumors in women of reproductive age, with clinical manifestations including abnormal menstruation, pelvic compression symptoms, and fertility impairment, all of which severely affect patients' quality of life [1,17]. Current treatment strategies primarily consist of pharmacotherapy, traditional surgery, and minimally invasive techniques [18,19]. Although pharmacotherapy can temporarily alleviate symptoms, long-term use is prone to inducing side effects associated with hypoestrogenism, and the recurrence rate is high after discontinuation of medication [20]. Traditional hysterectomy, while curative, is associated with significant trauma, prolonged recovery, and is not suitable for patients who need to preserve fertility [21]. In recent years, minimally invasive techniques such as laparoscopic or hysteroscopic myomectomy have gradually become more prevalent. These techniques reduce tissue damage through small incisions. However, obese patients, due to thick abdominal wall fat and difficult surgical field exposure, still face issues such as increased intraoperative bleeding and increased risk of postoperative infection. With the rapid development of medical technology, HIFU has achieved remarkable progress in the treatment of uterine fibroids, particularly in its unique therapeutic advantages for overweight and obese patients [8-10]. HIFU is characterized by precise targeting and localized treatment, focusing ultrasound energy directly on fibroid tissue to induce thermal effects that lead to coagulative necrosis of the fibroid tissue, while exerting minimal impact on surrounding normal tissues [22,23]. This non-invasive approach avoids the surgical trauma and prolonged recovery associated with traditional surgical procedures, reduces the risks of intraoperative bleeding and infection, and alleviates both physical pain and psychological burden for patients . Importantly, HIFU is especially suitable for overweight and obese patients, as it does not rely on surgical incisions and is unaffected by abdominal fat thickness. Furthermore, relevant studies suggest that HIFU may offer benefits for women who wish to preserve their fertility[24]. The short recovery period associated with HIFU treatment allows patients to resume normal life and work activities more quickly[25,26].Certainly, HIFU also has certain limitations. These include the relatively long treatment duration, which is particularly pronounced in obese patients or those with large fibroids, potentially necessitating fractionated treatment sessions. Additionally, fibroids located in specific anatomical sites, such as the anterior uterine wall, in close proximity to the bladder or bowel, may be challenging to completely ablate due to the obstruction of the ultrasound pathway or the risk of thermal injury to adjacent organs[26,27]. As a non-invasive therapeutic modality, HIFU has demonstrated significant advantages in the treatment of uterine fibroids in overweight/obese patients, while also presenting certain technical challenges. Based on clinical practice, we summarize the following experiences: First, precise targeting and energy control are crucial. Overweight/obese patients often have thicker abdominal fat layers, which may affect the penetration and focusing of ultrasound waves. Therefore, preoperative magnetic resonance imaging (MRI) is required to precisely assess the location, size, and relationship of the fibroid with surrounding tissues, and to formulate an appropriate treatment plan. During treatment, real-time monitoring of grayscale changes and dynamic adjustment of ultrasound power and energy deposition time are essential to ensure complete coverage of the target area while minimizing damage to surrounding tissues [27]. Second, sedation and analgesia management is important. Patients undergoing HIFU treatment need to maintain a fixed position for an extended period, which may cause discomfort. Therefore, a moderate sedation and analgesia protocol should be employed to enhance patient tolerance and reduce the impact of positional movement on treatment accuracy. Third, skin protection is crucial. Given the thicker abdominal fat layers in overweight/obese patients, skin protection is essential during treatment to prevent burns. This can be achieved by applying coupling gel to the treatment area, using cooling devices, and adjusting the angle of ultrasound wave incidence. Fourth, for fibroids that are deeply located or adjacent to vital organs such as the bowel or bladder, HIFU treatment can be challenging. Filling the bladder or rectum can increase the acoustic window and improve ultrasound penetration. Fifth, for fibroids with a diameter >10 cm, complete ablation in a single HIFU session may be difficult. A fractionated treatment strategy can be adopted, with the initial session aimed at reducing fibroid volume and alleviating symptoms, followed by subsequent sessions to consolidate the therapeutic effect. Additionally, preoperative use of gonadotropin-releasing hormone agonists (GnRH-a) can reduce fibroid volume and improve treatment success. Finally, common postoperative complications of HIFU include mild skin burns, transient abdominal pain, and pelvic effusion. Close monitoring of vital signs and timely symptomatic management, such as anti-inflammatory and analgesic treatments, are necessary [28]. For patients with pelvic effusion, ultrasound-guided puncture and drainage can be performed to alleviate symptoms. In this study, all patients in both groups successfully completed their treatments. Before treatment, there were no significant differences in the Symptom Severity Score (SSS) and Health-Related Quality of Life (HRQL) scores between the two groups. However, at 6 months and 1 year post-treatment, the observation group had significantly lower SSS scores and higher HRQL subscale scores compared to the control group. This indicates that patients treated with HIFU had a higher quality of life than those treated with laparoscopic myomectomy. The reasons for this are mainly that HIFU treatment requires only sedation and analgesia, without the need for general anesthesia, resulting in higher patient acceptance and lower psychological stress. Additionally, HIFU is minimally invasive, leaves no surgical wounds, and allows for a faster postoperative recovery, enabling patients to return to daily life and work more quickly and thus achieve a higher quality of life [25,26]. In this study, three patients in the control group experienced postoperative intestinal obstruction. One patient improved after conservative outpatient treatment, while the other two patients with more severe symptoms were readmitted for strict fasting, gastrointestinal decompression, and parenteral nutrition. Their intestinal obstruction was successfully resolved, and they were discharged after recovery. In summary, HIFU provides a safe and effective non-invasive treatment option for overweight/obese patients with uterine fibroids, offering advantages such as rapid recovery, minimal complications, and preservation of uterine function, thereby significantly improving patients' quality of life. Even though the procedural cost of HIFU is higher, the overall cost-effectiveness remains advantageous, with certain economic and social significance. The limitations of this study include the small sample size, short follow-up duration, and single-center, retrospective design. Future research should focus on expanding the sample size, conducting long-term follow-up studies, and participating in multicenter, prospective randomized controlled trials to further validate these conclusions. Declarations Conflict of interest All authors declare that no conflict of interest exists Authors’ contributions L.J.W and L.Y.Z wrote the main manuscript text, Q.Y.Z and L.N.H prepared figures 1, F.N.L and Z.W.C prepared Tables 1,2,3 and4, C.Y.L is the main surgeon of these surgeries. All authors reviewed the manuscript. Funding This work was supported by Startup Fund for scientific research, Fujian Medical University（Grant Number：2021QH1197） Data availability The datasets used and/or analysed during the current study available from the corresponding author on reasonable request. Ethics approval and consent to participate The retrospective medical review was approved by the institutional review board (IRB) of the Fujian Maternity and Child Health Hospital,.And the study was performed in accordance with the principles stated in the Declaration of Helsinki. All patients underwent a detailed pre-treatment evaluation to rule out malignancy, including clinical assessment, ultrasound, MRI, and biochemical marker testing. Written informed consent was obtained from all participating patients.All patients were managed with standard of care, and their spouses or authorized representatives were thoroughly informed about the surgical procedure, associated risks, and potential complications before the surgery.All patient privacy information is protected. Consent for publication All data in this study do not involve patient sensitive information, so this section is not applicable. Competing interests The authors declare no competing interests. Author details 1 College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, Fuzhou, China 2 Fujian Maternity and Child Health Hospital, Fuzhou, China References Giuliani E, As-Sanie S, Marsh EE. Epidemiology and management of uterine fibroids. Int J Gynaecol Obstet. 2020;149(1):3–9. Management of Symptomatic Uterine Leiomyomas. ACOG Practice Bulletin, Number 228. Obstet Gynecol. 2021;137(6):e100–15. Centini G, Cannoni A, Ginetti A, Colombi I, Giorgi M, Schettini G, Martire FG, Lazzeri L, Zupi E. Tailoring the Diagnostic Pathway for Medical and Surgical Treatment of Uterine Fibroids: A Narrative Review. Diagnostics (Basel). 2024;14(18):2046. Welsh A, Hammad M, Piña IL, Kulinski J. Obesity and cardiovascular health. Eur J Prev Cardiol. 2024;31(8):1026–35. Qin H, Lin Z, Vásquez E, Luan X, Guo F, Xu L. Association between obesity and the risk of uterine fibroids: a systematic review and meta-analysis. J Epidemiol Community Health. 2021;75(2):197–204. Dubuisson JB, O'Leary T, Feki A, Bouquet DE, Jolinière J, Dubuisson J. Laparoscopic myomectomy. Minerva Ginecol. 2016;68(3):345–51. Łoziński T, Filipowska J, Gurynowicz G, Gabriel I, Czekierdowski A. Non-invasive therapeutic use of High-Intensity Focused Ultrasound (HIFU) with 3 Tesla Magnetic Resonance Imaging in women with symptomatic uterine fibroids. Ginekol Pol. 2017;88(9):497–503. Dohmen S, Recker F, Ivanova Y, Strunk HM, Tonguc T, Ramig O et al. Ultrasound-guided high-intensity focused ultrasound for symptomatic uterine fibroids: clinical outcome of two European centers. Eur Radiol. 2024 Nov 29. Ali MM, Raphael Mpehle C, Olusola E, Ratshabedi PK, Ragab Shehata A, Ashraf Youssef M, Helal Farag EA. A systematic review of the side effects of high-intensity focused ultrasound ablation of uterine fibroids. Proc (Bayl Univ Med Cent). 2024;37(6):947–56. Kelso KR, Kohl-Thomas BM. HIFU for leiomyoma treatment. Proc (Bayl Univ Med Cent). 2024;37(6):957. Ali MM, Mpehle CR, Olusola E, et al. A systematic review of the side effects of high-intensity focused ultrasound ablation of uterine fibroids. Proc (Bayl Univ Med Cent). 2024;37(6):947–56. Ng VW, Cheung VY. Ultrasound-Guided High-Intensity Focused Ultrasound of Uterine Fibroids and Adenomyosis: An 11-Year Experience from a Single Center in Hong Kong. J Clin Med. 2024;13(16):4788. Spies JB, Coyne K, Guoau Guaou N, Boyle D, Skymarz-Murphy K, Gonzalves SM. The UFS-QOL, a new disease-specific symptom and health-related quality of life questionnaire for leiomyomata. Obstet Gynecol. 2002;99:290–300. Harding G, Coyne KS, Thompson CL, Spies JB. The responsiveness of the uterine fibroid symptom and health-related quality of life questionnaire (UFS-QOL). Health Qual Life Outcomes. 2008;6:99. Coyne KS, Margolis MK, Murphy J, Spies J. Validation of the UFS-QOL-hysterectomy questionnaire: modifying an existing measure for comparative effectiveness research. Value Health. 2012 Jul-Aug;15(5):674–9. Xu W, Chen W, Chen J, Hu L, Su X, Nie Y, Shi Q. Adaptability and clinical applicability of UFS-QoL in Chinese women with uterine fibroid. BMC Womens Health. 2022;22(1):372. De La Cruz MS, Buchanan EM. Uterine Fibroids: Diagnosis and Treatment. Am Fam Physician. 2017;95(2):100–7. Ahmad A, Kumar M, Bhoi NR, Badruddeen, Akhtar J, Khan MI, Ajmal M, Ahmad M. Diagnosis and management of uterine fibroids: current trends and future strategies. J Basic Clin Physiol Pharmacol. 2023;34(3):291–310. Stewart EA, Laughlin-Tommaso SK, Catherino WH, Lalitkumar S, Gupta D, Vollenhoven B. Uterine fibroids. Nat Rev Dis Primers. 2016;2:16043. Ali M, Ciebiera M, Wlodarczyk M, Alkhrait S, Maajid E, Yang Q, et al. Current and Emerging Treatment Options for Uterine Fibroids. Drugs. 2023;83(18):1649–75. Kan X, Shen X, Feng L, Hu Y, Yu J, Yang X. Comparison of safety and efficacy between laparoscopic myomectomy and traditional laparotomy for patients with uterine fibroids and their effect on pregnancy rate after surgery. Exp Ther Med. 2021;22(3):913. Anneveldt KJ, van 't Oever HJ, Nijholt IM, Dijkstra JR, Hehenkamp WJ, Veersema S, et al. Systematic review of reproductive outcomes after High Intensity Focused Ultrasound treatment of uterine fibroids. Eur J Radiol. 2021;141:109801. Patel N, Chaudhari K, Patel D, Joshi J. High-Intensity Focused Ultrasound Ablation of Uterine Fibroids: A Review. Cureus. 2023;15(9):e44680. Tempest N, Hapangama D. Should we be putting our scalpels down? Is HIFU the answer to fertility-sparing fibroid treatment? BJOG. 2018;125(3):366. Akhatova A, Aimagambetova G, Bapayeva G, Laganà AS, Chiantera V, Oppelt P, et al. Reproductive and Obstetric Outcomes after UAE, HIFU, and TFA of Uterine Fibroids: Systematic Review and Meta-Analysis. Int J Environ Res Public Health. 2023;20(5):4480. Matlac DM, Tonguc T, Mutschler N, Recker F, Ramig O, Strunk HM, et al. Study Protocol of a Prospective, Monocentric, Single-Arm Study Investigating the Safety and Efficacy of Local Ablation of Symptomatic Uterine Fibroids with US-Guided High-Intensity Focused Ultrasound (HIFU). J Clin Med. 2023;12(18):5926. Lee KW. The Asian perspective on HIFU. Int J Hyperth. 2021;38(2):5–8. Bao YM, Ma WW, Li S, Jiang L, Yang MJ, Chen JY. The safety and efficacy of myomectomy in the treatment of recurrent uterine fibroids after HIFU. Int J Gynaecol Obstet. 2024;167(3):997–1003. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Published Journal Publication published 22 May, 2025 Read the published version in BMC Women's Health → Version 1 posted Editorial decision: Revision requested 08 May, 2025 Editor assigned by journal 08 May, 2025 Reviews received at journal 09 Apr, 2025 Reviews received at journal 07 Apr, 2025 Reviewers agreed at journal 05 Apr, 2025 Reviewers agreed at journal 01 Apr, 2025 Reviewers invited by journal 31 Mar, 2025 Submission checks completed at journal 30 Mar, 2025 First submitted to journal 29 Mar, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-6080873","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":437051302,"identity":"99f4b10f-c65a-4649-a895-df5db6c673f8","order_by":0,"name":"Lijing Wu","email":"","orcid":"","institution":"College of Clinical Medicine for Obstetrics \u0026 Gynecology and Pediatrics, Fujian Medical University","correspondingAuthor":false,"prefix":"","firstName":"Lijing","middleName":"","lastName":"Wu","suffix":""},{"id":437051303,"identity":"c5918e33-fe5e-493c-b43f-e3687373cf6a","order_by":1,"name":"Liying Zhong","email":"","orcid":"","institution":"College of Clinical Medicine for Obstetrics \u0026 Gynecology and Pediatrics, Fujian Medical University","correspondingAuthor":false,"prefix":"","firstName":"Liying","middleName":"","lastName":"Zhong","suffix":""},{"id":437051304,"identity":"02010792-d46f-4a5f-a381-21f910043a38","order_by":2,"name":"Qingyan Zheng","email":"","orcid":"","institution":"College of Clinical Medicine for Obstetrics \u0026 Gynecology and Pediatrics, Fujian Medical University","correspondingAuthor":false,"prefix":"","firstName":"Qingyan","middleName":"","lastName":"Zheng","suffix":""},{"id":437051305,"identity":"c924d835-66ce-4e93-a196-f967929e79a4","order_by":3,"name":"Lingna Huang","email":"","orcid":"","institution":"College of Clinical Medicine for Obstetrics \u0026 Gynecology and Pediatrics, Fujian Medical University","correspondingAuthor":false,"prefix":"","firstName":"Lingna","middleName":"","lastName":"Huang","suffix":""},{"id":437051306,"identity":"2edadcf5-bbc0-4cf5-bbf2-8f9b4b0a30c8","order_by":4,"name":"Fengning Lin","email":"","orcid":"","institution":"College of Clinical Medicine for Obstetrics \u0026 Gynecology and Pediatrics, Fujian Medical University","correspondingAuthor":false,"prefix":"","firstName":"Fengning","middleName":"","lastName":"Lin","suffix":""},{"id":437051307,"identity":"cde4ab13-481d-40d1-b32a-b008de7fb21a","order_by":5,"name":"Zhiwei Chen","email":"","orcid":"","institution":"College of Clinical Medicine for Obstetrics \u0026 Gynecology and Pediatrics, Fujian Medical University","correspondingAuthor":false,"prefix":"","firstName":"Zhiwei","middleName":"","lastName":"Chen","suffix":""},{"id":437051308,"identity":"e9baf20c-0440-4955-8209-52929e7ddc77","order_by":6,"name":"Chengying Lian","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA2UlEQVRIiWNgGAWjYBACPmYwZcPDL3/4wIEPFURoYYNoSZOTnMGWeHDGGWK0QKjDxgY3eIwP87YQo4Wd+dmDn23MiQ23ez4c4G1gkOcXO0DIYWzmhr1tbImNc85uOCC5g8Fw5uwEQloYzKQZ23gSmxlyNxwwPMOQYHCboBb2b0AtEoltDDkPDgBJYrTwgGwxMOaRyGE4cJBILWWSPecS5CR4jhkcbDgjQdgv/PzHt0n8KPvPY3+8+fHnPxU28vzSBLSAASMbnClBhHIw+EOswlEwCkbBKBiRAADnpEJi9kPyNgAAAABJRU5ErkJggg==","orcid":"","institution":"College of Clinical Medicine for Obstetrics \u0026 Gynecology and Pediatrics, Fujian Medical University","correspondingAuthor":true,"prefix":"","firstName":"Chengying","middleName":"","lastName":"Lian","suffix":""}],"badges":[],"createdAt":"2025-02-21 15:53:14","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-6080873/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-6080873/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1186/s12905-025-03797-x","type":"published","date":"2025-05-22T15:58:34+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":79833927,"identity":"c3c607b2-3bf1-4631-a99b-ab92172940f2","added_by":"auto","created_at":"2025-04-03 11:06:05","extension":"jpeg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":423133,"visible":true,"origin":"","legend":"\u003cp\u003eMR images showing the maximum length plane of the treated fibroid from a 41-year-old woman with menorrhagia. (\u003cstrong\u003ea\u003c/strong\u003e) Pretreatment image shows the fibroid; (\u003cstrong\u003eb\u003c/strong\u003e) 6 months after treatment image shows the non-perfusion area and a reduction in the volume of the treated fibroid; (\u003cstrong\u003ec\u003c/strong\u003e) 1year after treatment image shows further shrinkage of the treated uterine fibroid volume and the persistence of non-perfusion areas. MR, magnetic resonance; B, bladder; CX, cervix; M, myoma; UT, uterine.\u003c/p\u003e","description":"","filename":"floatimage1.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-6080873/v1/c0054843b0f388884fb0adcb.jpeg"},{"id":83460560,"identity":"044376cf-397b-4852-a400-4799e2c0b67c","added_by":"auto","created_at":"2025-05-26 16:12:42","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":914361,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-6080873/v1/6697670b-48fd-4402-951e-859507483548.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Application of high intensity focused ultrasound in the treatment of uterine fibroids in overweight/obese women","fulltext":[{"header":"Introduction","content":"\u003cp\u003eUterine fibroids are the most common benign tumors of the female reproductive system, particularly prevalent among middle-aged women [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. In line with international guidelines and the latest evidence, treatment options for uterine fibroids include pharmacological therapy, minimally invasive procedures, and traditional surgical approaches. Pharmacological therapy mainly involves the use of gonadotropin-releasing hormone agonists (GnRH-a) to shrink the size of fibroids, thereby alleviating symptoms and preparing patients for surgery [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. Minimally invasive procedures, such as uterine artery embolization (UAE) and radiofrequency ablation (RFA), are also evolving. These techniques relieve symptoms by reducing the blood supply to fibroids or directly destroying fibroid tissue [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eWith societal development and lifestyle changes, the global prevalence of overweight and obesity has been steadily increasing [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e], which not only elevates the risk of uterine fibroids [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e], but also impacts the selection and efficacy of treatment methods. Traditional treatments, such as laparoscopic myomectomy, are effective but are associated with higher surgical risks, longer recovery periods, and potential adverse effects on fertility in overweight/obese patients [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. In recent years, High-Intensity Focused Ultrasound (HIFU) has emerged as a promising non-invasive therapeutic technology for uterine fibroids [\u003cspan additionalcitationids=\"CR8\" citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. HIFU focuses low-energy ultrasound waves from outside the body onto a target area within the body, creating a high-energy focal point. At this focal point, the energy of the ultrasound waves is converted into thermal energy, which rapidly increases the local tissue temperature and causes coagulative necrosis of the fibroid tissue. This thermal effect can precisely destroy the fibroid tissue while having minimal impact on surrounding normal tissues. This approach offers advantages such as being incision-free, bloodless, and enabling rapid recovery [\u003cspan additionalcitationids=\"CR11\" citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. However, there is limited research on the efficacy and safety of HIFU specifically for overweight/obese populations. This study aims to compare the outcomes of HIFU and laparoscopic myomectomy in the treatment of uterine fibroids in overweight/obese women.\u003c/p\u003e"},{"header":"Materials and methods","content":"\u003cp\u003eStudy Design\u003c/p\u003e\n\u003cp\u003eThis study is a retrospective analysis of clinical data from patients with uterine fibroids treated at our hospital between January 2022 and January 2024. The study compares the outcomes of High-Intensity Focused Ultrasound (HIFU) treatment and conventional laparoscopic myomectomy in overweight/obese women.\u003c/p\u003e\n\u003cp\u003eSelection Criteria\u003c/p\u003e\n\u003cp\u003ePatients were included if they met the following criteria: Diagnosis of uterine fibroids confirmed by clinical and imaging criteria; Categorized according to the International Federation of Gynecology and Obstetrics (FIGO) classification; Premenopausal women aged 18 years or older; Body Mass Index (BMI) calculated as weight (kg) divided by height squared (m\u0026sup2;), with overweight defined as 24 kg/m\u0026sup2; \u0026le; BMI \u0026lt; 28 kg/m\u0026sup2; and obesity defined as BMI \u0026ge; 28 kg/m\u0026sup2;, according to the Chinese Health Industry Standard \u0026quot;Criteria for Weight Assessment in Adults\u0026quot; (WS/T 428-2013); Non-pedunculated intramural/serosal fibroids (FIGO classification types 2-5), Maximum fibroid diameter between 2 cm and 10 cm, with the number of fibroids ranging from 1 to 5; No plans for pregnancy within the next 6 months.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eExclusion criteria included: Severe comorbidities or systemic dysfunction affecting major organs. Submucosal pedunculated fibroids. Patients with clinical or imaging findings suggestive of malignant lesions of the uterus or adnexa were excluded. Specific criteria included: Ultrasound findings: Irregular borders, heterogeneous echogenicity, cystic areas, and necrosis within the fibroid. MRI findings: High T2 signal intensity with hemorrhagic and necrotic changes, central non-enhancement on contrast-enhanced MRI, and apparent diffusion coefficient (ADC) values indicative of malignancy. Biochemical markers: Elevated serum lactate dehydrogenase (LDH) levels, particularly when combined with MRI findings. Clinical presentation: Postmenopausal women with uterine fibroids and no history of hormone replacement therapy, presenting with abnormal uterine bleeding or rapid tumor growth.\u003c/p\u003e\n\u003cp\u003eStudy Outcomes\u003c/p\u003e\n\u003cp\u003eThe outcomes assessed were perioperative indicators, symptom improvement (assessed by the Symptom Severity Score, SSS), health-related quality of life (HRQL score)[13-16], complications, and recurrence rates at 1-year post-treatment.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eEthical Statement\u003c/p\u003e\n\u003cp\u003eThe retrospective medical review was approved by the institutional review board (IRB) of the Fujian Maternity and Child Health Hospital,.And the study was performed in accordance with the principles stated in the Declaration of Helsinki. All patients underwent a detailed pre-treatment evaluation to rule out malignancy, including clinical assessment, ultrasound, MRI, and biochemical marker testing. Written informed consent was obtained from all participating patients.All patients were managed with standard of care, and their spouses or authorized representatives were thoroughly informed about the surgical procedure, associated risks, and potential complications before the surgery.All patient privacy information is protected.\u003c/p\u003e\n\u003cp\u003eData Collection\u003c/p\u003e\n\u003cp\u003eData were collected retrospectively from the medical records of 155 overweight/obese women with uterine fibroids. The data included age, BMI, number of fibroids, maximum fibroid diameter, preoperative hemoglobin levels, and postoperative outcomes. The HIFU treatment group (n=75) and the laparoscopic myomectomy group (n=80) were compared.\u003c/p\u003e\n\u003cp\u003eSurgical Techniques\u003c/p\u003e\n\u003cp\u003eHIFU Treatment:\u0026nbsp;Preoperative preparations included bowel preparation, routine skin preparation, and urinary catheterization. The treatment area was degreased and degassed. Patients were positioned supine on the treatment table, and intravenous access was established. Pre-treatment scanning was performed to localize the fibroids, followed by sedation and analgesia as needed. Contrast-enhanced ultrasound was used to visualize blood flow signals in the target area and define the treatment range. The HIFU probe was activated with the following parameters configured: pulse duration of 0.02\u0026ndash;0.08 seconds, interval time of 0.01\u0026ndash;0.08 seconds, 10 pulses per treatment, and a treatment power of 300\u0026ndash;340 watts. Parameters were adjusted based on the lesion characteristics. Treatment was terminated when a significant grayscale change was observed in the target area. Post-treatment contrast-enhanced ultrasound was performed to confirm the absence of blood flow signals, indicating effective treatment. Intraoperative fluid management was maintained, and the urinary catheter was removed postoperatively, with patients advised to rest in bed. Patients were advised to refrain from attempting pregnancy for at least 6 months following the procedure to allow for adequate healing and monitoring of potential complications.\u003c/p\u003e\n\u003cp\u003eLaparoscopic Myomectomy: Preoperative preparations included bowel preparation, routine skin preparation, and urinary catheterization. Under general anesthesia, patients were placed in the lithotomy position, and a pneumoperitoneum was established. Pitocin was injected into the uterine body, and the fibroids were bluntly dissected and removed for pathological examination. The fibroid cavity and seromuscular layer were sutured intermittently with absorbable sutures. The laparoscopic suture technique used in this study was standardized, employing 2-0 Vicryl sutures for all procedures. Postoperative care followed standard protocols.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eAll surgeries were performed by the same experienced surgical team to ensure consistency in surgical technique. For the control group, conventional laparoscopic myomectomy was performed using a standardized approach. The laparoscopic suture technique involved the use of 2-0 Vicryl sutures for intermittent suturing of the fibroid cavity and seromuscular layer. The study was approved by the Startup Fund for scientific research, Fujian Medical University (Approval No: 2021QH1197)\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eStatistical analysis\u003c/p\u003e\n\u003cp\u003eStatistical analysis was conducted using SPSS 22.0 statistical software. For continuous data, the Shapiro-Wilk test was employed to assess normality. If the Shapiro-Wilk test yielded a p-value \u0026gt; 0.05, the data were considered to follow a normal distribution; otherwise, the data were deemed non-normally distributed. For normally distributed data, results were expressed as mean \u0026plusmn; standard deviation (x\u0026plusmn;s), and between-group comparisons were performed using independent sample t-tests. For non-normally distributed data, results were expressed as median (Q1, Q3), and between-group comparisons were conducted using the Mann-Whitney U test. Categorical data were presented as percentages (%), and between-group comparisons were carried out using the chi-square test. A p-value \u0026lt; 0.05 was considered statistically significant.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003eBased on their preferences, 75 patients underwent HIFU treatment, designated as the Observation Group (OG), while 80 patients received conventional laparoscopic myomectomy, designated as the Control Group (CG). In the OG, 49 patients were overweight, and 26 were obese. In the CG, 52 patients were overweight, and 28 were obese. Data collected from both groups included age, Body Mass Index (BMI), number of fibroids, maximum fibroid diameter, and preoperative hemoglobin (Hb) levels. Comparative analysis showed no significant differences in baseline characteristics between the two groups (P \u0026gt; 0.05), indicating comparability (Table 1). A typical case is shown in Figure 1.\u003c/p\u003e\n\u003cp\u003eTable\u0026nbsp;1. Baseline Patient Characteristics\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 27.2887%;\"\u003e\n \u003cp\u003eGroup (n)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 23.2394%;\"\u003e\n \u003cp\u003eOG(n=75)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 23.2394%;\"\u003e\n \u003cp\u003eCG (n=80)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13.0282%;\"\u003e\n \u003cp\u003et/\u0026chi;2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13.2042%;\"\u003e\n \u003cp\u003eP\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 27.2887%;\"\u003e\n \u003cp\u003eAge(year)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 23.2394%;\"\u003e\n \u003cp\u003e37.51 \u0026plusmn; 5.82\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 23.2394%;\"\u003e\n \u003cp\u003e38.48 \u0026plusmn; 4.90\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13.0282%;\"\u003e\n \u003cp\u003e-1.12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13.2042%;\"\u003e\n \u003cp\u003e0.263\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 27.2887%;\"\u003e\n \u003cp\u003eoverweight(count)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 23.2394%;\"\u003e\n \u003cp\u003e49（65.33%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 23.2394%;\"\u003e\n \u003cp\u003e52（65%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13.0282%;\"\u003e\n \u003cp\u003e0.002\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13.2042%;\"\u003e\n \u003cp\u003e0.965\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 27.2887%;\"\u003e\n \u003cp\u003eBMI(kg/m2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 23.2394%;\"\u003e\n \u003cp\u003e27.11 \u0026plusmn; 1.94\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 23.2394%;\"\u003e\n \u003cp\u003e27.10 \u0026plusmn; 1.85\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13.0282%;\"\u003e\n \u003cp\u003e0.02\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13.2042%;\"\u003e\n \u003cp\u003e0.982\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 27.2887%;\"\u003e\n \u003cp\u003eNumber of fibroids (count)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 23.2394%;\"\u003e\n \u003cp\u003e2.37 \u0026plusmn; 0.98\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 23.2394%;\"\u003e\n \u003cp\u003e2.42 \u0026plusmn; 0.96\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13.0282%;\"\u003e\n \u003cp\u003e-0.33\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13.2042%;\"\u003e\n \u003cp\u003e0.742\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 27.2887%;\"\u003e\n \u003cp\u003eMaximum diameter of uterine fibroid (cm)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 23.2394%;\"\u003e\n \u003cp\u003e4.86 \u0026plusmn; 1.96\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 23.2394%;\"\u003e\n \u003cp\u003e4.75 \u0026plusmn; 1.86\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13.0282%;\"\u003e\n \u003cp\u003e0.35\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13.2042%;\"\u003e\n \u003cp\u003e0.730\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 27.2887%;\"\u003e\n \u003cp\u003eHb value of preoperative (g/L)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 23.2394%;\"\u003e\n \u003cp\u003e96.75 \u0026plusmn; 6.38\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 23.2394%;\"\u003e\n \u003cp\u003e96.53 \u0026plusmn; 6.24\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13.0282%;\"\u003e\n \u003cp\u003e0.22\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13.2042%;\"\u003e\n \u003cp\u003e0.827\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eOG,Observation Group ; CG,Control Group; BMI,Body Mass Index; Hb,Hemoglobin\u003c/p\u003e\n\u003cp\u003eBoth the observation group and the control group successfully completed the surgeries. Before treatment, there was no significant difference in the Symptom Severity Score (SSS) between the two groups, with no statistical significance observed (P \u0026gt; 0.05). At 6 months and 1 year post-treatment, the SSS in the observation group was significantly lower than that in the control group. Meanwhile, the Health-Related Quality of Life (HRQL) subscale scores in the observation group were significantly higher than those in the control group, with statistical significance (P \u0026lt; 0.05). These results are comparable between the two groups.(Table 2).\u003c/p\u003e\n\u003cp\u003eTable 2 \u0026nbsp;SSS scores of two groups pre- and postoperation(mean\u0026plusmn;SD, score)\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 36.9069%;\"\u003e\n \u003cp\u003eGroup (n)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 20.9139%;\"\u003e\n \u003cp\u003eOG(n=75)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19.6837%;\"\u003e\n \u003cp\u003eCG (n=80)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12.8295%;\"\u003e\n \u003cp\u003et\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 9.66608%;\"\u003e\n \u003cp\u003eP\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 36.9069%;\"\u003e\n \u003cp\u003ePreoperative\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20.9139%;\"\u003e\n \u003cp\u003e30.03\u0026plusmn;1.73\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 19.6837%;\"\u003e\n \u003cp\u003e29.56\u0026plusmn;1.47\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12.8295%;\"\u003e\n \u003cp\u003e1.80\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9.66608%;\"\u003e\n \u003cp\u003e0.074\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 36.9069%;\"\u003e\n \u003cp\u003eSix months postoperatively\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20.9139%;\"\u003e\n \u003cp\u003e12.61\u0026plusmn;1.22\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 19.6837%;\"\u003e\n \u003cp\u003e15.89\u0026plusmn;1.21\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12.8295%;\"\u003e\n \u003cp\u003e-16.77\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9.66608%;\"\u003e\n \u003cp\u003e0.000\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 36.9069%;\"\u003e\n \u003cp\u003eOne year postoperatively\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20.9139%;\"\u003e\n \u003cp\u003e10.40\u0026plusmn;1.27\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 19.6837%;\"\u003e\n \u003cp\u003e12.03\u0026plusmn;1.33\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12.8295%;\"\u003e\n \u003cp\u003e-7.76\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9.66608%;\"\u003e\n \u003cp\u003e0.000\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eOG,Observation Group ; CG,Control Group\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eBefore treatment, there was no significant difference in the Health-Related Quality of Life (HRQL) scores between the two groups, with no statistical significance observed (P \u0026gt; 0.05). At 6 months and 1 year post-treatment, the HRQL subscale scores in the observation group were significantly higher than those in the control group, with statistical significance (P \u0026lt; 0.05). These results are comparable between the two groups. (Table 3).\u003c/p\u003e\n\u003cp\u003eTable3 HRQL scores of two groups pre- and postoperation(mean\u0026plusmn;SD, score)\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 37.6761%;\"\u003e\n \u003cp\u003eGroup (n)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 23.9437%;\"\u003e\n \u003cp\u003eOG(n=75)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19.0141%;\"\u003e\n \u003cp\u003eCG (n=80)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 9.6831%;\"\u003e\n \u003cp\u003et\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 9.6831%;\"\u003e\n \u003cp\u003eP\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 37.6761%;\"\u003e\n \u003cp\u003ePreoperative\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 23.9437%;\"\u003e\n \u003cp\u003e81.95\u0026plusmn;1.38\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 19.0141%;\"\u003e\n \u003cp\u003e81.75\u0026plusmn;1.59\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9.6831%;\"\u003e\n \u003cp\u003e0.82\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9.6831%;\"\u003e\n \u003cp\u003e0.414\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 37.6761%;\"\u003e\n \u003cp\u003eSix months postoperatively\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 23.9437%;\"\u003e\n \u003cp\u003e89.35\u0026plusmn;1.90\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 19.0141%;\"\u003e\n \u003cp\u003e84.69\u0026plusmn;1.24\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9.6831%;\"\u003e\n \u003cp\u003e18.20\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9.6831%;\"\u003e\n \u003cp\u003e0.000\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 37.6761%;\"\u003e\n \u003cp\u003eOne year postoperatively\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 23.9437%;\"\u003e\n \u003cp\u003e94.19\u0026plusmn;1.16\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 19.0141%;\"\u003e\n \u003cp\u003e91.69\u0026plusmn;1.32\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9.6831%;\"\u003e\n \u003cp\u003e12.51\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9.6831%;\"\u003e\n \u003cp\u003e0.000\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eOG,Observation Group ; CG,Control Group\u003c/p\u003e\n\u003cp\u003ePostoperative complications were compared between the two groups. The observation group had a lower total incidence of postoperative complications than the control group, with a statistically significant difference (P \u0026lt; 0.05). (Table 4). Both groups were followed up for 1 year postoperatively, and no recurrence or further enlargement of uterine fibroids was observed in either group.\u003c/p\u003e\n\u003cp\u003eTable 4 \u0026nbsp;Comparison of postoperative complications between the two groups [n(%)]\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 28.169%;\"\u003e\n \u003cp\u003eGroup (n)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 27.8169%;\"\u003e\n \u003cp\u003eOG(n=75)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24.6479%;\"\u003e\n \u003cp\u003eCG (n=80)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 9.6831%;\"\u003e\n \u003cp\u003ec2\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 9.6831%;\"\u003e\n \u003cp\u003eP\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 28.169%;\"\u003e\n \u003cp\u003ePostoperative Fever\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 27.8169%;\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 24.6479%;\"\u003e\n \u003cp\u003e7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9.6831%;\"\u003e\n \u003cp\u003e0.24\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9.6831%;\"\u003e\n \u003cp\u003e0.628\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 28.169%;\"\u003e\n \u003cp\u003eVaginal Bleeding\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 27.8169%;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 24.6479%;\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9.6831%;\"\u003e\n \u003cp\u003e1.15\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9.6831%;\"\u003e\n \u003cp\u003e0.283\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 28.169%;\"\u003e\n \u003cp\u003ePostoperative Intestinal Obstruction\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 27.8169%;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 24.6479%;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9.6831%;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9.6831%;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 28.169%;\"\u003e\n \u003cp\u003eReadmission\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 27.8169%;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 24.6479%;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9.6831%;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9.6831%;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 28.169%;\"\u003e\n \u003cp\u003eTotal Occurrence\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 27.8169%;\"\u003e\n \u003cp\u003e7(9.33)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 24.6479%;\"\u003e\n \u003cp\u003e17(21.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9.6831%;\"\u003e\n \u003cp\u003e4.20\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9.6831%;\"\u003e\n \u003cp\u003e0.040\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eOG,Observation Group ; CG,Control Group\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eUterine leiomyomas are the most common benign tumors in women of reproductive age, with clinical manifestations including abnormal menstruation, pelvic compression symptoms, and fertility impairment, all of which severely affect patients\u0026apos; quality of life [1,17]. Current treatment strategies primarily consist of pharmacotherapy, traditional surgery, and minimally invasive techniques [18,19]. Although pharmacotherapy can temporarily alleviate symptoms, long-term use is prone to inducing side effects associated with hypoestrogenism, and the recurrence rate is high after discontinuation of medication [20]. Traditional hysterectomy, while curative, is associated with significant trauma, prolonged recovery, and is not suitable for patients who need to preserve fertility [21]. In recent years, minimally invasive techniques such as laparoscopic or hysteroscopic myomectomy have gradually become more prevalent. These techniques reduce tissue damage through small incisions. However, obese patients, due to thick abdominal wall fat and difficult surgical field exposure, still face issues such as increased intraoperative bleeding and increased risk of postoperative infection.\u003c/p\u003e\n\u003cp\u003eWith the rapid development of medical technology, HIFU has achieved remarkable progress in the treatment of uterine fibroids, particularly in its unique therapeutic advantages for overweight and obese patients [8-10]. HIFU is characterized by precise targeting and localized treatment, focusing ultrasound energy directly on fibroid tissue to induce thermal effects that lead to coagulative necrosis of the fibroid tissue, while exerting minimal impact on surrounding normal tissues [22,23]. This non-invasive approach avoids the surgical trauma and prolonged recovery associated with traditional surgical procedures, reduces the risks of intraoperative bleeding and infection, and alleviates both physical pain and psychological burden for patients . Importantly, HIFU is especially suitable for overweight and obese patients, as it does not rely on surgical incisions and is unaffected by abdominal fat thickness. Furthermore, relevant studies suggest that HIFU may offer benefits for women who wish to preserve their fertility[24]. The short recovery period associated with HIFU treatment allows patients to resume normal life and work activities more quickly[25,26].Certainly, HIFU also has certain limitations. These include the relatively long treatment duration, which is particularly pronounced in obese patients or those with large fibroids, potentially necessitating fractionated treatment sessions. Additionally, fibroids located in specific anatomical sites, such as the anterior uterine wall, in close proximity to the bladder or bowel, may be challenging to completely ablate due to the obstruction of the ultrasound pathway or the risk of thermal injury to adjacent organs[26,27].\u003c/p\u003e\n\u003cp\u003eAs a non-invasive therapeutic modality, HIFU has demonstrated significant advantages in the treatment of uterine fibroids in overweight/obese patients, while also presenting certain technical challenges. Based on clinical practice, we summarize the following experiences: First, precise targeting and energy control are crucial. Overweight/obese patients often have thicker abdominal fat layers, which may affect the penetration and focusing of ultrasound waves. Therefore, preoperative magnetic resonance imaging (MRI) is required to precisely assess the location, size, and relationship of the fibroid with surrounding tissues, and to formulate an appropriate treatment plan. During treatment, real-time monitoring of grayscale changes and dynamic adjustment of ultrasound power and energy deposition time are essential to ensure complete coverage of the target area while minimizing damage to surrounding tissues [27]. Second, sedation and analgesia management is important. Patients undergoing HIFU treatment need to maintain a fixed position for an extended period, which may cause discomfort. Therefore, a moderate sedation and analgesia protocol should be employed to enhance patient tolerance and reduce the impact of positional movement on treatment accuracy. Third, skin protection is crucial. Given the thicker abdominal fat layers in overweight/obese patients, skin protection is essential during treatment to prevent burns. This can be achieved by applying coupling gel to the treatment area, using cooling devices, and adjusting the angle of ultrasound wave incidence. Fourth, for fibroids that are deeply located or adjacent to vital organs such as the bowel or bladder, HIFU treatment can be challenging. Filling the bladder or rectum can increase the acoustic window and improve ultrasound penetration. Fifth, for fibroids with a diameter \u0026gt;10 cm, complete ablation in a single HIFU session may be difficult. A fractionated treatment strategy can be adopted, with the initial session aimed at reducing fibroid volume and alleviating symptoms, followed by subsequent sessions to consolidate the therapeutic effect. Additionally, preoperative use of gonadotropin-releasing hormone agonists (GnRH-a) can reduce fibroid volume and improve treatment success. Finally, common postoperative complications of HIFU include mild skin burns, transient abdominal pain, and pelvic effusion. Close monitoring of vital signs and timely symptomatic management, such as anti-inflammatory and analgesic treatments, are necessary [28]. For patients with pelvic effusion, ultrasound-guided puncture and drainage can be performed to alleviate symptoms.\u003c/p\u003e\n\u003cp\u003eIn this study, all patients in both groups successfully completed their treatments. Before treatment, there were no significant differences in the Symptom Severity Score (SSS) and Health-Related Quality of Life (HRQL) scores between the two groups. However, at 6 months and 1 year post-treatment, the observation group had significantly lower SSS scores and higher HRQL subscale scores compared to the control group. This indicates that patients treated with HIFU had a higher quality of life than those treated with laparoscopic myomectomy. The reasons for this are mainly that HIFU treatment requires only sedation and analgesia, without the need for general anesthesia, resulting in higher patient acceptance and lower psychological stress. Additionally, HIFU is minimally invasive, leaves no surgical wounds, and allows for a faster postoperative recovery, enabling patients to return to daily life and work more quickly and thus achieve a higher quality of life [25,26]. In this study, three patients in the control group experienced postoperative intestinal obstruction. One patient improved after conservative outpatient treatment, while the other two patients with more severe symptoms were readmitted for strict fasting, gastrointestinal decompression, and parenteral nutrition. Their intestinal obstruction was successfully resolved, and they were discharged after recovery.\u003c/p\u003e\n\u003cp\u003eIn summary, HIFU provides a safe and effective non-invasive treatment option for overweight/obese patients with uterine fibroids, offering advantages such as rapid recovery, minimal complications, and preservation of uterine function, thereby significantly improving patients\u0026apos; quality of life. Even though the procedural cost of HIFU is higher, the overall cost-effectiveness remains advantageous, with certain economic and social significance. The limitations of this study include the small sample size, short follow-up duration, and single-center, retrospective design. Future research should focus on expanding the sample size, conducting long-term follow-up studies, and participating in multicenter, prospective randomized controlled trials to further validate these conclusions.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eConflict of interest All authors declare that no conflict of interest exists\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026rsquo; contributions\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eL.J.W and L.Y.Z wrote the main manuscript text, Q.Y.Z and L.N.H prepared figures 1, \u0026nbsp; F.N.L and Z.W.C prepared Tables 1,2,3 and4, C.Y.L is the main surgeon of these surgeries. All authors reviewed the manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis work was supported by Startup Fund for scientific research, Fujian Medical University（Grant Number：2021QH1197）\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData availability \u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe datasets used and/or analysed during the current study available from the corresponding author on reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe retrospective medical review was approved by the institutional review board (IRB) of the Fujian Maternity and Child Health Hospital,.And the study was performed in accordance with the principles stated in the Declaration of Helsinki. All patients underwent a detailed pre-treatment evaluation to rule out malignancy, including clinical assessment, ultrasound, MRI, and biochemical marker testing. Written informed consent was obtained from all participating patients.All patients were managed with standard of care, and their spouses or authorized representatives were thoroughly informed about the surgical procedure, associated risks, and potential complications before the surgery.All patient privacy information is protected.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll data in this study do not involve patient sensitive information, so this section is not applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare no competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor details\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e1 College of Clinical Medicine for Obstetrics \u0026amp; Gynecology and Pediatrics, Fujian Medical University, Fuzhou, China\u003c/p\u003e\n\u003cp\u003e2 Fujian Maternity and Child Health Hospital, Fuzhou, China\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eGiuliani E, As-Sanie S, Marsh EE. Epidemiology and management of uterine fibroids. Int J Gynaecol Obstet. 2020;149(1):3\u0026ndash;9.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eManagement of Symptomatic Uterine Leiomyomas. ACOG Practice Bulletin, Number 228. Obstet Gynecol. 2021;137(6):e100\u0026ndash;15.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCentini G, Cannoni A, Ginetti A, Colombi I, Giorgi M, Schettini G, Martire FG, Lazzeri L, Zupi E. Tailoring the Diagnostic Pathway for Medical and Surgical Treatment of Uterine Fibroids: A Narrative Review. Diagnostics (Basel). 2024;14(18):2046.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWelsh A, Hammad M, Pi\u0026ntilde;a IL, Kulinski J. Obesity and cardiovascular health. Eur J Prev Cardiol. 2024;31(8):1026\u0026ndash;35.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eQin H, Lin Z, V\u0026aacute;squez E, Luan X, Guo F, Xu L. Association between obesity and the risk of uterine fibroids: a systematic review and meta-analysis. J Epidemiol Community Health. 2021;75(2):197\u0026ndash;204.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDubuisson JB, O'Leary T, Feki A, Bouquet DE, Jolini\u0026egrave;re J, Dubuisson J. Laparoscopic myomectomy. Minerva Ginecol. 2016;68(3):345\u0026ndash;51.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eŁoziński T, Filipowska J, Gurynowicz G, Gabriel I, Czekierdowski A. Non-invasive therapeutic use of High-Intensity Focused Ultrasound (HIFU) with 3 Tesla Magnetic Resonance Imaging in women with symptomatic uterine fibroids. Ginekol Pol. 2017;88(9):497\u0026ndash;503.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDohmen S, Recker F, Ivanova Y, Strunk HM, Tonguc T, Ramig O et al. Ultrasound-guided high-intensity focused ultrasound for symptomatic uterine fibroids: clinical outcome of two European centers. Eur Radiol. 2024 Nov 29.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAli MM, Raphael Mpehle C, Olusola E, Ratshabedi PK, Ragab Shehata A, Ashraf Youssef M, Helal Farag EA. A systematic review of the side effects of high-intensity focused ultrasound ablation of uterine fibroids. Proc (Bayl Univ Med Cent). 2024;37(6):947\u0026ndash;56.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKelso KR, Kohl-Thomas BM. HIFU for leiomyoma treatment. Proc (Bayl Univ Med Cent). 2024;37(6):957.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAli MM, Mpehle CR, Olusola E, et al. A systematic review of the side effects of high-intensity focused ultrasound ablation of uterine fibroids. Proc (Bayl Univ Med Cent). 2024;37(6):947\u0026ndash;56.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eNg VW, Cheung VY. Ultrasound-Guided High-Intensity Focused Ultrasound of Uterine Fibroids and Adenomyosis: An 11-Year Experience from a Single Center in Hong Kong. J Clin Med. 2024;13(16):4788.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSpies JB, Coyne K, Guoau Guaou N, Boyle D, Skymarz-Murphy K, Gonzalves SM. The UFS-QOL, a new disease-specific symptom and health-related quality of life questionnaire for leiomyomata. Obstet Gynecol. 2002;99:290\u0026ndash;300.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHarding G, Coyne KS, Thompson CL, Spies JB. The responsiveness of the uterine fibroid symptom and health-related quality of life questionnaire (UFS-QOL). Health Qual Life Outcomes. 2008;6:99.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCoyne KS, Margolis MK, Murphy J, Spies J. Validation of the UFS-QOL-hysterectomy questionnaire: modifying an existing measure for comparative effectiveness research. Value Health. 2012 Jul-Aug;15(5):674\u0026ndash;9.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eXu W, Chen W, Chen J, Hu L, Su X, Nie Y, Shi Q. Adaptability and clinical applicability of UFS-QoL in Chinese women with uterine fibroid. BMC Womens Health. 2022;22(1):372.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDe La Cruz MS, Buchanan EM. Uterine Fibroids: Diagnosis and Treatment. Am Fam Physician. 2017;95(2):100\u0026ndash;7.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAhmad A, Kumar M, Bhoi NR, Badruddeen, Akhtar J, Khan MI, Ajmal M, Ahmad M. Diagnosis and management of uterine fibroids: current trends and future strategies. J Basic Clin Physiol Pharmacol. 2023;34(3):291\u0026ndash;310.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eStewart EA, Laughlin-Tommaso SK, Catherino WH, Lalitkumar S, Gupta D, Vollenhoven B. Uterine fibroids. Nat Rev Dis Primers. 2016;2:16043.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAli M, Ciebiera M, Wlodarczyk M, Alkhrait S, Maajid E, Yang Q, et al. Current and Emerging Treatment Options for Uterine Fibroids. Drugs. 2023;83(18):1649\u0026ndash;75.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKan X, Shen X, Feng L, Hu Y, Yu J, Yang X. Comparison of safety and efficacy between laparoscopic myomectomy and traditional laparotomy for patients with uterine fibroids and their effect on pregnancy rate after surgery. Exp Ther Med. 2021;22(3):913.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAnneveldt KJ, van 't Oever HJ, Nijholt IM, Dijkstra JR, Hehenkamp WJ, Veersema S, et al. Systematic review of reproductive outcomes after High Intensity Focused Ultrasound treatment of uterine fibroids. Eur J Radiol. 2021;141:109801.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePatel N, Chaudhari K, Patel D, Joshi J. High-Intensity Focused Ultrasound Ablation of Uterine Fibroids: A Review. Cureus. 2023;15(9):e44680.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eTempest N, Hapangama D. Should we be putting our scalpels down? Is HIFU the answer to fertility-sparing fibroid treatment? BJOG. 2018;125(3):366.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAkhatova A, Aimagambetova G, Bapayeva G, Lagan\u0026agrave; AS, Chiantera V, Oppelt P, et al. Reproductive and Obstetric Outcomes after UAE, HIFU, and TFA of Uterine Fibroids: Systematic Review and Meta-Analysis. Int J Environ Res Public Health. 2023;20(5):4480.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMatlac DM, Tonguc T, Mutschler N, Recker F, Ramig O, Strunk HM, et al. Study Protocol of a Prospective, Monocentric, Single-Arm Study Investigating the Safety and Efficacy of Local Ablation of Symptomatic Uterine Fibroids with US-Guided High-Intensity Focused Ultrasound (HIFU). J Clin Med. 2023;12(18):5926.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLee KW. The Asian perspective on HIFU. Int J Hyperth. 2021;38(2):5\u0026ndash;8.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBao YM, Ma WW, Li S, Jiang L, Yang MJ, Chen JY. The safety and efficacy of myomectomy in the treatment of recurrent uterine fibroids after HIFU. Int J Gynaecol Obstet. 2024;167(3):997\u0026ndash;1003.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-womens-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bmwh","sideBox":"Learn more about [BMC Women's Health](http://bmcwomenshealth.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bmwh/default.aspx","title":"BMC Women's Health","twitterHandle":"","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"High-Intensity Focused Ultrasound, Uterine Fibroids, Overweight, Obesity, Women","lastPublishedDoi":"10.21203/rs.3.rs-6080873/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-6080873/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eObjective\u003c/strong\u003e To investigate the clinical efficacy and safety of High-Intensity Focused Ultrasound (HIFU) in the treatment of uterine fibroids in overweight/obese women.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods \u003c/strong\u003eA retrospective analysis was conducted on the clinical data of 155 overweight/obese women with uterine fibroids treated at our hospital between January 2022 and January 2024. Among them, 75 patients underwent HIFU treatment (observation group), while 80 patients received conventional laparoscopic myomectomy (control group). Perioperative indicators, symptom improvement (assessed by the Symptom Severity Score, SSS), health-related quality of life (HRQL score), complications, and recurrence rates at 1-year post-treatment were compared between the two groups.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults \u003c/strong\u003eAll procedures were successfully completed in both groups. No significant differences were observed in baseline characteristics such as age, BMI, number of fibroids, maximum fibroid diameter, and hemoglobin levels between the two groups (P \u0026gt; 0.05). At 6 months and 1 year post-treatment, the observation group showed significantly better SSS scores (12.61 ± 1.22 vs. 15.89 ± 1.21; 10.40 ± 1.27 vs. 12.03 ± 1.33) and HRQL scores (89.35 ± 1.90 vs. 84.69 ± 1.24; 94.19 ± 1.16 vs. 91.69 ± 1.32) compared to the control group (P \u0026lt; 0.05). The total complication rate in the observation group was significantly lower than that in the control group (9.33% vs. 21.3%, χ² = 4.34, P = 0.04). No recurrence or fibroid enlargement was observed in the observation group at 1-year follow-up.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion \u003c/strong\u003eHIFU is an effective and safe treatment for uterine fibroids in overweight/obese women, offering advantages such as minimal invasiveness, fewer complications, and faster recovery. It represents a superior minimally invasive option for this patient population.\u003c/p\u003e","manuscriptTitle":"Application of high intensity focused ultrasound in the treatment of uterine fibroids in overweight/obese women","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-04-03 10:58:00","doi":"10.21203/rs.3.rs-6080873/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2025-05-08T09:39:54+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-05-08T09:37:23+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-04-09T06:26:28+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-04-07T06:59:00+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"161512581163365531193850833417770533530","date":"2025-04-05T14:07:23+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"8538714028260121414266869036463379268","date":"2025-04-01T19:21:55+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-04-01T00:09:42+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-03-31T03:48:07+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Women's Health","date":"2025-03-29T15:52:37+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-womens-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bmwh","sideBox":"Learn more about [BMC Women's Health](http://bmcwomenshealth.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bmwh/default.aspx","title":"BMC Women's Health","twitterHandle":"","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"861a261b-a97f-4e90-bb60-e7cbc7419a03","owner":[],"postedDate":"April 3rd, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2025-05-26T16:08:19+00:00","versionOfRecord":{"articleIdentity":"rs-6080873","link":"https://doi.org/10.1186/s12905-025-03797-x","journal":{"identity":"bmc-womens-health","isVorOnly":false,"title":"BMC Women's Health"},"publishedOn":"2025-05-22 15:58:34","publishedOnDateReadable":"May 22nd, 2025"},"versionCreatedAt":"2025-04-03 10:58:00","video":"","vorDoi":"10.1186/s12905-025-03797-x","vorDoiUrl":"https://doi.org/10.1186/s12905-025-03797-x","workflowStages":[]},"version":"v1","identity":"rs-6080873","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-6080873","identity":"rs-6080873","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}