The comprehensive application of conservative treatment for adenomyosis
10.3760/cma.j.cn431274-20200504-00553
- VernacularTitle:子宫腺肌病保守治疗的综合应用
- Author:
Xiaodi BI
;
Junqi MA
- From:
Journal of Chinese Physician
2021;23(5):663-667,673
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To investigate the clinical effects of high-intensity focused ultrasound (HIFU), gonadotropin-releasing hormone agonist (GnRH-a), and levonorgestrel intrauterine extended-release system (LNG-IUS) on adenomyosis (AM) alone or in combination.Methods:The clinical and follow-up data of 338 AM patients who received conservative treatment in the First Affiliated Hospital of Xinjiang Medical University from July 2018 to March 2019 were analyzed retrospectively. The treatment related parameters, dysmenorrhea (VAS) score, menstrual volume (PBAC) score, uterine volume, recurrence rate of dysmenorrhea, hemoglobin (Hb) and carbohydrate antigen 125 (CA125) levels at 3, 6, and 12 months after treatment were compared among HIFU treatment (H group), GnRH-a treatment (G group), LNG-IUS treatment (L group), HIFU combined with GnRH-a treatment (H+ G group), HIFU combined with LNG-IUS treatment (H+ L group), HIFU combined with GnRH-a and LNG-IUS treatment (H+ G+ L group).Results:There was no significant difference in sound power, treatment time and ablation rate among the four HIFU groups ( P>0.05). The dysmenorrhea score, menstrual volume score, and CA125 levels in the 6 groups were significantly lower than before treatment ( P<0.05). The hemoglobin level of H group, H+ G group, H+ L group, H+ G+ L group continued to increase after treatment ( P<0.05). The VAS scores of the H+ G, H+ L, and H+ G+ L groups were significantly lower than those of the H and L groups at 3 and 6 months after treatment ( P<0.05). G group and H+ G group alleviated 100% of dysmenorrhea after 3 months of treatment, and the curative effect decreased afterwards. The recurrence rate of dysmenorrhea was 19.44%, 30.16%, 26.67%, 7.30%, 8.10%, 3.77% in H group, G group, L group, H+ G group, H+ L group, and H+ G+ L group, respectively ( P<0.05). The PBAC scores in the H+ G, H+ L, and H+ G+ L groups were significantly lower than those in the H, L, and G groups at 6 and 12 months after treatment ( P<0.05). The uterus volum in group L before treatment was smaller than that of the other groups ( P<0.05), and the uterus volume increased slightly in 3 months, 6 months, and 12 months after treatment than before treatment, but with no statistically significant difference ( P>0.05). The uterine volume of G, H+ G, and H+ G+ L groups were smaller than that of H and G groups at 3 months after treatment, and the uterine volume of group G at 12 months after treatment was larger than that at 3 and 6 months after treatment, but still smaller than before treatment ( P<0.05). The uterine volume, dysmenorrhea score, and menstrual volume score of the H+ G+ L group at 12 months after treatment were [(157.33±35.96)cm 3, (1.07±0.82)point, (69.57±17.24)point], which were all smaller than those of the other groups ( P<0.05). Conclusions:HIFU, GnRH-a, LNG-IUS alone or combined treatment of AM are safe and effective, but comprehensive treatment can improve clinical efficacy, delay and reduce recurrence and reduce the incidence of total hysterectomy.
