A Comparative Study Of Pelvic Adhesions After Focused Ultrasound Ablation Of Uterine Fibroids And Myomectomy

Objective: To compare the pelvic adhesions in patients with uterine fibroids who underwent myomectomy and focused ultrasound ablation(FUA),and analyze the factors affecting pelvic adhesions.Methods: A total of 282 patients with uterine leiomyoma who had undergone myomectomy or FUA and reoperation were selected from Suining Central Hospital from January 2014 to October 2020.They were divided into two groups according to previous treatment: previous operation group(n=79)and previous FUA group(n=203).The reoperation records of the two groups were collected,and the pelvic adhesions of the two groups were statistically analyzed according to the pelvic adhesion scoring rules,and the influencing factors of pelvic adhesion were analyzed by univariate analysis and logistic regression model.Results:(1)There was no significant difference in the general data between the previous operation group and the previous FUA group,including the patient’s age,the maximum diameter of the lesion,the times of induced abortion,the times of delivery and the times of pregnancy(P>0.05).(2)The incidence of pelvic adhesion in the previous operation group was higher than that in the previous FUA group,and the difference was statistically significant(62.0%vs.46.8%).There was significant difference in the degree of pelvic adhesion and the distribution of pelvic adhesion between the two groups(P<0.032),and the percentage of mild adhesion in the previous FUA group was higher than that in the previous operation group,while the percentage of severe adhesion in the previous operation group was lower than that in the previous operation group.There was no significant difference in the incidence of tubal adhesion and ovarian adhesion between the two groups,but the incidences of tubal atresia and uterine rectal lacuna closure in the previous operation group were significantly higher than those in the previous FUA group(P<0.05).(3)In the previous operation group and the previous FUA group,there was no significant difference in the distribution of delivery times between those with and without pelvic adhesions(P=0.333,0.888).Stratified analysis,the results showed that: in the previous operation group,the incidence of pelvic adhesions in patients aged >40 years was significantly higher than that in patients aged <35 years(P < 0.0167);the number of induced abortions was between 2 and 5 and >5 times.The incidence of pelvic adhesions was significantly higher in those with less than 2 induced abortions(P<0.0167);the incidence of pelvic adhesions in those with the largest diameter of uterine fibroids >5cm was higher than that in those with the largest diameter of uterine fibroids <4cm(P<0.0167);In the previous FUA group,the incidence of pelvic adhesions in those aged 35-40 years was significantly higher than that in those aged <35 years(P<0.0167).The patients with the lesion diameter greater than 5cm were more likely to have pelvic adhesions than those with the lesion diameter less than 4cm(P<0.0167).Multivariate logistic regression analysis of the two groups showed that the number of induced abortions and the largest diameter of the lesions were independent influencing factors of pelvic adhesions.Conclusion: The incidence and degree of pelvic adhesions after FUA treatment of uterine fibroids were lower than those of myomectomy.This may be related to the diameter of the lesion and the number of induced abortions.