Efficacy of the heat balance technique in percutaneous microwave ablation for uterine fibroids

doi:10.3877/cma.j.issn.1672-6448.2026.04.007

Abstract

Abstract:

Objective

To evaluate the clinical efficacy and safety of the heat balance (HB) technique in percutaneous microwave ablation (PMWA) for uterine fibroids by comparing with the conventional single-needle, multi-point, multi-plane ablation method.

Methods

A retrospective analysis was conducted on 40 patients with symptomatic uterine fibroids who underwent PMWA at Zhejiang Hospital between January 2024 and January 2025. The patients were divided into a study group (n=20) and a control group (n=20). Comparison metrics included the number of needle insertions, ablation time, operation time, ablation coverage, volume reduction rate (VRR) at 6 months postoperatively, incidence of complications, and improvement in clinical symptoms [uterine fibroid volume, hemoglobin concentration, uterine fibroid symptoms, and health-related quality of life (UFS-QoL) score], all evaluated using a single-factor analysis method (independent sample t-test or U-test).

Results

The study group required significantly fewer needle insertions [1.00 (1.00, 2.00) vs 5.00 (4.00, 6.25), Z=-5.526, P＜0.001], shorter ablation time [7.00 (6.00, 9.25) min vs 30.00 (22.00, 35.00) min, Z=-5.430, P＜0.001], and shorter total procedural time [(37.65±2.37) min vs (60.80±7.76) min, t=-12.765, P＜0.001] than the control group. No significant differences were observed between the two groups in ablation ratio (93.25%±2.63% vs 93.40%±4.66%, P＞0.05) or six-month VRR [72.13% (67.96%, 75.76%) vs 74.72% (66.63%, 78.12%), P＞0.05]. No major complications occurred in either group. Both groups showed significant improvements in hemoglobin concentration and UFS-QoL scores post-treatment (P＜0.05).

Conclusion

The HB technique achieves comparable short-term therapeutic efficacy to the conventional method while substantially reducing the number of needle insertions and procedural time, representing a faster, safer, and more efficient approach for PMWA of uterine fibroids.

Key words: Uterine fibroids, Ultrasound-guided, Microwave ablation, Heat balance technique

Boyi Wang, Bin Huang, Xixi Sun, Yongqiang Hong, Shengbo Wu, Han Wang, Qianqian Qi. Efficacy of the heat balance technique in percutaneous microwave ablation for uterine fibroids[J]. Chinese Journal of Medical Ultrasound (Electronic Edition), 2026, 23(04): 307-315.

/ / Recommend

Add to citation manager EndNote|Ris|BibTeX

URL: https://chaosheng.cma-cmc.com.cn/EN/10.3877/cma.j.issn.1672-6448.2026.04.007

https://chaosheng.cma-cmc.com.cn/EN/Y2026/V23/I04/307

Figures/Tables 7

项目	热平衡术式组（20例）	单针多点多切面消融组（20例）	统计值	P值
年龄（岁， $x ¯$ ± s）	43.80±4.43	41.60±5.80	t=1.348	0.186
子宫肌瘤体积[cm³，M（Q₁，Q₃）]	104.72（90.42，131.68）	107.16（70.73，158.32）	Z=-0.176	0.860
子宫肌瘤最大径[cm，M（Q₁，Q₃）]	6.80（6.00，7.25）	6.55（6.03，6.85）	Z=-0.080	0.940
血红蛋白浓度（g/L， $x ¯$ ± s）	101.75±23.17	90.50±15.75	t=-1.226	0.228
UFS评分（分， $x ¯$ ± s）	16.05±2.26	14.65±2.46	t=1.877	0.068
QoL评分（分， $x ¯$ ± s）	68.95±18.15	74.85±17.58	t=-1.044	0.303
FIGO分型（例）			χ²=1.652	0.800
2型	2	1
3型	4	4
4型	5	5
5型	4	7
6型	5	3
肌瘤位置（例）			χ²=0.370	0.831
前壁	13	14
后壁	5	5
侧壁	2	1

项目	热平衡术式组（20例）	单针多点多切面消融组（20例）	统计值	P值
年龄（岁， $x ¯$ ± s）	43.80±4.43	41.60±5.80	t=1.348	0.186
子宫肌瘤体积[cm³，M（Q₁，Q₃）]	104.72（90.42，131.68）	107.16（70.73，158.32）	Z=-0.176	0.860
子宫肌瘤最大径[cm，M（Q₁，Q₃）]	6.80（6.00，7.25）	6.55（6.03，6.85）	Z=-0.080	0.940
血红蛋白浓度（g/L， $x ¯$ ± s）	101.75±23.17	90.50±15.75	t=-1.226	0.228
UFS评分（分， $x ¯$ ± s）	16.05±2.26	14.65±2.46	t=1.877	0.068
QoL评分（分， $x ¯$ ± s）	68.95±18.15	74.85±17.58	t=-1.044	0.303
FIGO分型（例）			χ²=1.652	0.800
2型	2	1
3型	4	4
4型	5	5
5型	4	7
6型	5	3
肌瘤位置（例）			χ²=0.370	0.831
前壁	13	14
后壁	5	5
侧壁	2	1

组别	例数	子宫肌瘤体积（cm³）	血红蛋白浓度（g/L）	UFS（分）	QoL（分）
热平衡术式组	20
术前		104.72（90.42，131.68）	101.75±23.17	16.00（14.75，17.00）	68.95±18.15
术后6个月		30.72（19.68，43.36）	114.50±15.43	11.00（9.00，13.00）	42.10±9.51
统计值		Z=-2.948	t=-2.048	Z=-4.611	t=5.860
P值		0.003	0.048	＜0.001	＜0.001
单针多点多切面消融组	20
术前		120.10±62.79	90.50±15.75	14.65±2.46	71.00（62.75，88.50）
术后6个月		31.94±15.59	102.95±10.82	11.45±2.06	47.50（35.00，63.25）
统计值		t=6.094	t=-2.914	t=4.461	Z=-3.480
P值		＜0.001	0.006	＜0.001	0.001

组别	例数	消融范围（%， $x ¯$ ±s）	术后6个月VRR[%，M（Q₁，Q₃）]	消融时间[min，M（Q₁，Q₃）]	手术时间（min， $x ¯$ ±s）	布针次数[次，M（Q₁，Q₃）]	采用水隔离保护（例）	住院时间[d，M（Q₁，Q₃）]
热平衡术式组	20	93.25±2.63	72.13（67.96，75.76）	7.00（6.00，9.25）	37.65±2.37	1.00（1.00，2.00）	0	3.00（3.00，3.00）
单针多点多切面消融组	20	93.40±4.66	74.72（66.63，78.12）	30.00（22.00，35.00）	60.80±7.76	5.00（4.00，6.25）	10	3.00（3.00，3.00）
统计值		t=-1.226	Z=-0.799	Z=-5.430	t=-12.765	Z=-5.526	-	Z=0.000
P值		0.228	0.424	＜0.001	＜0.001	＜0.001	＜0.001	1.000

组别	例数	消融范围（%， $x ¯$ ±s）	术后6个月VRR[%，M（Q₁，Q₃）]	消融时间[min，M（Q₁，Q₃）]	手术时间（min， $x ¯$ ±s）	布针次数[次，M（Q₁，Q₃）]	采用水隔离保护（例）	住院时间[d，M（Q₁，Q₃）]
热平衡术式组	20	93.25±2.63	72.13（67.96，75.76）	7.00（6.00，9.25）	37.65±2.37	1.00（1.00，2.00）	0	3.00（3.00，3.00）
单针多点多切面消融组	20	93.40±4.66	74.72（66.63，78.12）	30.00（22.00，35.00）	60.80±7.76	5.00（4.00，6.25）	10	3.00（3.00，3.00）
统计值		t=-1.226	Z=-0.799	Z=-5.430	t=-12.765	Z=-5.526	-	Z=0.000
P值		0.228	0.424	＜0.001	＜0.001	＜0.001	＜0.001	1.000

组别	例数	疼痛	阴道排液	阴道黏膜损伤	盆腔感染	肠道损伤
热平衡术式组	20	5	5	0	0	0
单针多点多切面消融组	20	7	5	0	1	0
χ²值		0.476	0.000	-	-	-
P值		0.490	1.000	-	1.000	-

References 35

1	Mension E, Carmona F, Vannuccini S, et al. Clinical signs and diagnosis of fibroids from adolescence to menopause [J]. Fertil Steril, 2024, 122(1): 12-19.
2	Mohammadi R, Tabrizi R, Hessami K, et al. Correlation of low serum vitamin-D with uterine leiomyoma: a systematic review and meta-analysis [J]. Reprod Biol Endocrinol, 2020, 18(1): 85.
3	Jensen KK, Pyle C, Foster BR, et al. Adenomyosis in pregnancy: diagnostic pearls and pitfalls [J]. Radiographics, 2021, 41(3): 929-944.
4	子宫肌瘤的诊治中国专家共识专家组. 子宫肌瘤的诊治中国专家共识 [J]. 中华妇产科杂志, 2017, 52(12): 793-800.
5	Metwally M, Raybould G, Cheong YC, et al. Surgical treatment of fibroids for subfertility [J]. Cochrane Database Syst Rev, 2020, 1(1): CD003857.
6	中华医学会超声医学分会, 中华医学会妇科肿瘤学分会, 中国医师协会介入医师分会, 等. 超声引导微波消融治疗子宫腺肌病临床应用专家共识(2024版) [J]. 中华超声影像学杂志, 2024, 33(9): 737-759.
7	Wu T, Zheng B, Tan L, et al. A novel parallel overlapping mode for complete ablation of large benign thyroid nodules in a single-session radiofrequency ablation [J]. Front Endocrinol (Lausanne), 2022, 13: 915303.
8	Sun X, Zhao Y, Chen J, et al. Clinical efficacy of the novel heat-balance technique in ultrasound-guided percutaneous microwave ablation for uterine fibroids: a retrospective study [J]. Eur J Radiol, 2025, 195: 112594.
9	Munro MG, Critchley HOD, Fraser IS. The two FIGO systems for normal and abnormal uterine bleeding symptoms and classification of causes of abnormal uterine bleeding in the reproductive years: 2018 revisions [J]. Int J Gynaecol Obstet, 2018, 143(3): 393-408.
10	Xu W, Chen W, Chen J, et al. Adaptability and clinical applicability of UFS-QoL in Chinese women with uterine fibroid [J]. BMC Womens Health, 2022, 22(1): 372.
11	超声引导经皮热消融治疗子宫肌瘤全国多中心研究协作组. 超声引导经皮微波(射频)消融治疗子宫肌瘤临床应用指南(2017) [J/CD]. 中华医学超声杂志(电子版), 2018, 15(2): 90-94.
12	Hai N, Zhang J, Xu R, et al. Percutaneous microwave ablation with artificial ascites for symptomatic uterine adenomyosis: initial experience [J]. Int J Hyperthermia, 2017, 33(6): 646-652.
13	Wang J, Xu P, Zou G, et al. Integrating spatial transcriptomics and single-nucleus RNA sequencing reveals the potential therapeutic strategies for uterine leiomyoma [J]. Int J Biol Sci, 2023, 19(8): 2515-2530.
14	Kleidon A. The second law of thermodynamics, life and Earth's planetary machinery revisited [J]. Phys Life Rev, 2024, 51: 382-389.
15	Liu L, Wang T, Lei B. Image-guided thermal ablation in the management of symptomatic adenomyosis: a systematic review and meta-analysis [J]. Int J Hyperthermia, 2021, 38(1): 948-962.
16	Zhao WP, Han ZY, Zhang J, et al. A retrospective comparison of microwave ablation and high intensity focused ultrasound for treating symptomatic uterine fibroids [J]. Eur J Radiol, 2015, 84(3): 413-417.
17	Su HH, Guo DM, Chen PS, et al. A method to protect the endometrium for microwave ablation treating types 1-3 uterine fibroids: a preliminary comparative study [J]. Int J Hyperthermia, 2023, 40(1): 2223369.
18	Jonsdottir G, Beermann M, Lanz E, et al. Ultrasound guided microwave ablation treatment of uterine fibroids: clinical response and patient acceptability [J]. Acta Obstet Gynecol Scand, 2025, 104(2): 350-356.
19	Liao L, Chen L, Melamed A, et al. Use of conservative therapies before hysterectomy for uterine leiomyomas [J]. Obstet Gynecol, 2023, 141(2): 371-374.
20	Piriyev E, Schiermeier S, Bends R, et al. Transcervical radiofrequency ablation of fibroids that are 5 cm or larger in women with abnormal uterine bleeding [J]. J Gynecol Obstet Hum Reprod, 2022, 51(2): 102303.
21	Xia J, Teng D, Sui G, et al. Effectiveness and safety of ultrasound-guided percutaneous microwave ablation for a single uterine fibroid greater than 300 cm(3) [J]. J Minim Invasive Gynecol, 2023, 30(4): 290-299.
22	Song Y, Wu M, Zhou R, et al. Application and evaluation of hydrodissection in microwave ablation of liver tumours in difficult locations [J]. Front Oncol, 2023, 13: 1298757.
23	Li S, Zhou F, Zhang Y, et al. Multi-stage automatic and rapid ablation and needle trajectory planning method for CT-guided percutaneous liver tumor ablation [J]. Med Phys, 2025, 52(1): 113-130.
24	Cubo-Abert M, Simó-González M, Haimovich S, et al. The importance of the pseudocapsule in the management of uterine myoma: state of the art and expert recommendations [J]. Int J Gynaecol Obstet, 2025, 171(2): 639-645.
25	Klimek K, Mader N, Happel C, et al. Heat sink effects in thyroid bipolar radiofrequency ablation: an ex vivo study [J]. Sci Rep, 2023, 13(1): 19288.
26	Fu Y, Feng Q, Zhang S, et al. Application of oxytocin in ultrasound-guided percutaneous microwave ablation for treatment of hypervascular uterine fibroids: a preliminary report [J]. Int J Hyperthermia, 2019, 36(1): 761-767.
27	Worakitsitisatorn A, Lu DS, Lee MW, et al. Percutaneous thermal ablation of subcapsular hepatocellular carcinomas: influence of tumor-surface contact and protrusion on therapeutic efficacy and safety [J]. Eur Radiol, 2020, 30(3): 1813-1821.
28	Hui TCH, Brace CL, Hinshaw JL, et al. Microwave ablation of the liver in a live porcine model: the impact of power, time and total energy on ablation zone size and shape [J]. Int J Hyperthermia, 2020, 37(1): 668-676.
29	Andreozzi A, Brunese L, Iasiello M, et al. Numerical analysis of the pulsating heat source effects in a tumor tissue [J]. Comput Methods Programs Biomed, 2021, 200: 105887.
30	Kim JS, Ko Y, Kwon H, et al. Impact of energy and access methods on extrahepatic tumor spreading and the ablation zone: an ex vivo experiment using a subcapsular tumor model [J]. Korean J Radiol, 2019, 20(4): 580-588.
31	Lee B, Marhalik-Helms J, Penzi L. Anesthesia risk alert program: a proactive safety initiative [J]. Jt Comm J Qual Patient Saf, 2023, 49(9): 441-449.
32	Zhang Q, Liang X, Chen Z. An Updated review of thermal ablation technology for uterine fibroids and adenomyosis: focusing on protecting fertility [J]. Int J Womens Health, 2024, 16: 1551-1563.
33	Santalla-Hernández Á, Naveiro-Fuentes M, Benito-Villena R, et al. Efficacy, complications, and factors predictive of response to treatment with transvaginal radiofrequency ablation for symptomatic uterine myomas [J]. J Minim Invasive Gynecol, 2022, 29(6): 743-752.
34	Kwon CS, Abu-Alnadi ND. Updates on the surgical approach to fibroids: the importance of radiofrequency ablation [J]. Semin Intervent Radiol, 2023, 40(4): 335-341.
35	Rey VE, Falcon MM, Ferrara I, et al. Pregnancy outcomes after transvaginal radiofrequency ablation of leiomyomas [J]. Obstet Gynecol, 2025, 145(3): 346-353.

[1]	Xinyu Gao, Kaiyi Yang, Huiting Chen, Li Zhu, Yabin Fang, Mei Song, Jinshu Zeng. Efficacy of ultrasound-guided microwave ablation versus reoperation for cervical metastatic lymph nodes in patients after surgery for papillary thyroid cancer [J]. Chinese Journal of Medical Ultrasound (Electronic Edition), 2025, 22(09): 858-867.
[2]	Weiqi Ji, Kunping Li, Xianna Dou, Zhiwei Guo, Shuru Wei. Application of quality control circle in improving accuracy of ultrasound diagnosis of uterine fibroids [J]. Chinese Journal of Medical Ultrasound (Electronic Edition), 2025, 22(05): 427-433.
[3]	Yaru Zhang, Chuan Pang, Yu Pang, Fangying Fan, Ping Liang, Jie Yu. Effect of ablation on quality of life and depressive status in patients with T1N0M0 papillary thyroid cancer [J]. Chinese Journal of Medical Ultrasound (Electronic Edition), 2025, 22(04): 328-336.
[4]	Xiaoli Yang, Chuansheng Yang. Clinical efficacy of ultrasound-guided microwave ablation in non-lactating mastitis [J]. Chinese Journal of Breast Disease(Electronic Edition), 2025, 19(06): 348-351.
[5]	Yunlong Li, Xuliang Xia, Wei Liu, Zhiqiang Jiang, Li Tang, Kai Liu, Haozhong Liu, Siyuan Zhang. Comparison of microwave ablation and TOET in the treatment of T1N0M0 stage papillary thyroid carcinoma [J]. Chinese Journal of Operative Procedures of General Surgery(Electronic Edition), 2025, 19(03): 341-344.
[6]	Benfa Xie, Juhui Niu, Miaohua Han, Rui He, Qingbing Zhang, Wei Xu. Comparison of analgesic effects of ultrasound-guided anterior and posterior quadratus lumborum block after inguinal hernia repair [J]. Chinese Journal of Hernia and Abdominal Wall Surgery(Electronic Edition), 2026, 20(01): 58-61.
[7]	Feifei Lu, Jun Wang, Zhiwei Jiang, Xiumei Feng, Hongguang Quan, Jing Liu. The effect of nalbuphine combined with ropivacaine for ultrasound-guided iliohypogastric/ilioinguinal nerve block on postoperative pain and early recovery in patients undergoing inguinal hernia repair [J]. Chinese Journal of Hernia and Abdominal Wall Surgery(Electronic Edition), 2025, 19(03): 296-300.
[8]	Fang Yang, Jiangrong Liao, Dan Zhang, Yuxiang Zhou, Mupo Liu, Xiulin Wu, Ting Jiang. Comparative analysis of the efficacy of CT-Guided microwave ablation and cryoablation in the treatment of pulmonary nodules and lung cancer [J]. Chinese Journal of Lung Diseases(Electronic Edition), 2026, 19(01): 70-75.
[9]	Yuanyuan He, Lingli Ju, Yunping Wang, Yihua Jin, Lingxia Li, Lu Bai, Na Zhuo, Li Wei. Clinical evaluation of hysteroscopic myomectomy with electrosection for FIGO type 3 uterine fibroids [J]. Chinese Journal of Laparoscopic Surgery(Electronic Edition), 2025, 18(06): 354-360.
[10]	Xiaoying Zhong, Yang Cao, Xin Yu, Honghui Shi, Haiyuan Liu. Comparison of efficacy and safety between single-port and multi-port laparoscopy in the removal of large uterine fibroids [J]. Chinese Journal of Laparoscopic Surgery(Electronic Edition), 2025, 18(06): 348-353.
[11]	Xuan Yu, Xuqi He, Guanghui Guo, Lei Tan, Kai Li, Qingjin Zeng. Safety and efficacy of novel microwave ablation system for perivascular and non-perivascular liver cancer [J]. Chinese Journal of Hepatic Surgery(Electronic Edition), 2025, 14(06): 888-893.
[12]	Xingfu Duan, Jianzhong Tang, Zhiwei Sun, Yesheng Chen, Bo Gao, Zhenhao Fei. Clinical efficacy of laparoscopic microwave ablation via retroperitoneal approach for recurrent hepatocellular carcinoma [J]. Chinese Journal of Hepatic Surgery(Electronic Edition), 2025, 14(06): 919-924.
[13]	Bao Liu, Xiaochen Su, Guangfei Li, Mingjing Xu. Effect of ultrasound-guided percutaneous transhepatic gallbladder drainage on the recovery of liver function, gastrointestinal function, and serum inflammatory indicators in patients with acute cholecystitis [J]. Chinese Journal of Digestion and Medical Imageology(Electronic Edition), 2026, 16(01): 73-78.
[14]	Yi Deng, Wei Cui, Jingjing Chen, Yanqing Le, Jinghua Cui, Suyi Ye, Yuxi Chen, Yongheng Chen, Yongyu Li, Jingqi Chen, Bing Yuan, Rongde Xu, Jing Li. The effects of low-power and high-power microwave ablation on the ablation zones in normal porcine lung tissue [J]. Chinese Journal of Interventional Radiology(Electronic Edition), 2025, 13(04): 366-372.
[15]	Yuqi Liu, Jian Li, Jie Zhong, Qun Li, Shuai Chang, Chunpeng Yu. Clinical efficacy and safety analysis of microwave ablation synchronized with hepatic artery chemoembolization combined with targeted and immune therapy for large hepatocellular carcinoma [J]. Chinese Journal of Interventional Radiology(Electronic Edition), 2025, 13(02): 110-116.

Please choose a citation manager

Content to export