Analysis Of The Potential Impact Of Factors Of The Therapeutic Effec Of Hifu Treatment In Patients With Adenomyosis

Background:Adenomyosis is a common benign pathology that is defined by the presence of endometrial glands and stroma within the myometrium. Adenomyosis is usually affecting multiparous women with the age from 30 to 50 years. On histology, it is characterized by the presence of ectopic endometrial mucosa within the myometrium (invagination of endometrium in the myometrium at a depth of at least 2.5 mm below the basal layer of the endometrium) that leads to hypertrophy of the smooth muscle, which confirms the diagnosis. It can be either focal or diffuse and it is often asymmetric, predominating in the posterior uterine corpus. Regarding the pathogenic mechanism of adenomyosis, strong evidence suggests that the migratory and invasive properties of endometrial epithelial cells can be induced by oestrogen. Symptoms of adenomyosis typically include menorrhagia, chronic pelvic pain and dysmenorrhea. At present, surgery and drug therapy were still the major treatments for aenomyosis. Then, patients with fertility requirements and patients in perimenopausal period were more suitable for drug therapy. And patients in severe conditions and patients without good drug therapy response were the indications of surgery treatment. High-intensity focused ultrasound (HIFU) is a non-invasive approach that uses a precisely delivered ultrasound energy to achieve target area tissues and cells necrosis without radiation or surgical excision. Nowadays, HIFU has been widely used in the treatment of several kinds of gynecologic diseases, such as adenomyosis and hysteromyoma. HIFU is a technique that uses focused ultrasound waves to thermally ablate a portion of tissue situated at the focal point, rising target area temperature to induce thermal tissue coagulation, necrosis and heat shock. Otherwise, cavitation erosion and mechanical effect were also involved in HIFU induced target tissues and cells necrosis, without the damage in around normal tissues. So, it has more advantages than others for adenomyosis patients with the requirements of saving uterus and fertility.Objective:1. Initially, the first purpose of this retrospective study was to explore the effect of HIFU on symptoms relieving in child-bearing period patients with adenomyosis.2. To explore the size of ablation area, features of adenomyoma and mass presentation in surgery on the therapeutic effect of HIFU treatment.3. To investigate the value of physical and mental care therapy on symptom improvement in patients with adenomyosis after HIFU treatment.Methods:In our study, according to our included criteria,97 adenomyosis patients with HIFU treatment were participated. Before and 1 month,3 month,6 month and 12 month after HIFU treatment, the severity of dysmenorrhea and menstrual blood volume were recorded and analyzed. Then, the impacts of fertility statues, size of ablation area, features of adenomyoma and mass presentation in surgery on the therapeutic effect of HIFU treatment were analyzed by us. At last, the value of physical and mental care therapy on symptom improvement in patients with adenomyosis after HIFU treatment was also evaluated in this study.Results:1. One month,3 month,6 month and 12 month after HIFU treatment, the severity of dysmenorrhea and menstrual blood volume were all significantly improved (P<0.05 in all). Meanwhile, no severe adverse reaction was observed in all patients.2. Our data suggested that the features of adenomyoma and mass presentation in surgery all showed no impact on the therapeutic effect of HIFU treatment, at the time points of month 6 (P>0.05 in all). Meanwhile, we also found that size of ablation area was associated with the therapeutic effect of HIFU treatment, at the time points of month 6 (P<0.05).3. Meanwhile, our results also figured out that physical and mental care therapy could improve the symptom of patients with adenomyosis after HIFU treatment (P<0.05).Conclusions:1. HIFU was a safe and effective therapy for the treatment of patients with adenomyosis. HIFU not just can relieve the symptoms, but also can improve the life quality of adenomyosis patients.2. The features of adenomyoma and mass presentation in surgery were not the potential impact factor of the therapeutic effect of HIFU treatment. However, size of ablation area could impact it’s effect.3. Physical and mental care therapy was an effective and useful treatment to enhance the therapeutic effect of HIFU treatment in patients with adenomyosis. However, more clinical studies should be carried out to further evaluation.