| Objective:Adenomyopathy is a common and intractable gynecological disorder that occurs in women of childbearing age between 30 and 50 years.The main clinical symptoms are excessive menstruation,prolonged menstruation,progressive dysmenorrhea and so on.One of the common causes of abnormal uterine bleeding is adenomyopathy,which is mainly manifested as menorrhagia,prolonged menstrual period,and even blood collapse.In severe cases,it may lead to extremely severe anemia,repeated blood transfusion,etc.It usually seriously affects patients’physical,psychological and economic quality of life.At present,the effective treatment of adenomyosis is limited,and the radical treatment is hysterectomy.However,in recent years,our country become rich,and people’s life has been greatly improved.As a result,women’s requirements for the quality of life are also rising,so the desire to keep the uterus is becoming more and more strong.A number of domestic and foreign studies have confirmed that high-intensity focused ultrasound ablation therapy can make the focal coagulation necrosis of adenomyosis,thus relieving some patients with menorrhagia and dysmenorrhea and other clinical symptoms,but the effect is not ideal for patients with menorrhagia,especially patients with diffuse adenomyosis.thermal balloon endometrial ablation(TBEA)ablation was performed to ablate the uterine functional layer and basal layer,improving symptoms of abnormal uterine bleeding.The purpose of this study was to investigate the clinical effect of high-intensity focused ultrasound(HIFU)ablation combined with thermal balloon endometrial ablation(TBEA)in the treatment of abnormal uterine bleeding caused by adenomyosis in patients with abnormal uterine bleeding caused by adenomyosis due to drug therapy failure,inability to tolerate or reluctance to drug therapy.Methods:A total of 200 patients with adenomyosis who received medical treatment in Mianyang Central Hospital from February 2021 to October 2022and met the inclusion criteria after the screening of exclusion criteria,failed first-line drug therapy,could not tolerate drug therapy or were unwilling to drug therapy were selected.All patients had clinical manifestations of Abnormal uterine bleeding(AUB).According to the patients’treatment intention,200patients were divided into study group(HIFU+TBEA group)and control group(HIFU alone group),100 patients in HIFU+TBEA group and 100 patients in HIFU alone group.The study group was treated with HIFU ablation technique combined with TBEA.The control group was treated with HIFU ablation technique alone.To compare the clinical effects of HIFU ablation alone and HIFU ablation combined with TBEA in the treatment of abnormal uterine bleeding caused by adenomyosis.The clinical effects of HIFU ablation alone and HIFU ablation technique combined with TBEA in the treatment of dysmenorrhea caused by adenomyosis,changes in uterine volume and improvements in hemoglobin levels were compared in a minor way.Adverse reactions were observed at the same time.Results:1.In the study group,100 patients were treated with HIFU combined with TBEA,and the cure rate of menometrorrhagia was 90%(90/100)--30 patients had amenorrhea in 30%(30/100),the improvement rate was10%(10/100),and the effective rate was 100%(100/100).The cure rate of dysmenorrhea symptoms was 22%(22/100),the recovery rate was 67%(67/100),and the effective rate was 89%(89/100).2.In the control group,100 patients were treated with HIFU alone,the cure rate of menometrorrhagia was 57%(57/100),the improvement rate was13%(13/100),the effective rate was 70%(70/100),and 30%(30/100)had no obvious effect;The cure rate of dysmenorrhea symptoms was 5%(5/100),the improvement rate was 72%(72/100),and the effective rate was 77%(77/100),among which 23%(23/100)had no obvious effect.After treatment,the cure rate and effective rate of menometrorrhagia in HIFU+TBEA group were higher than those in HIFU alone group.χ~2=35.29,P<0.001,the difference was statistically significant.After treatment,the cure rate and effective rate of HIFU ablation combined with TBEA were higher than those of HIFU alone,χ~2=5.103,P=0.024,the difference was statistically significant.3.Compared with before treatment,the scores of menstrual volume at 1,3and 6 months after treatment were decreased in both groups(P<0.05),and there were statistically significant differences.Compared with HIFU group alone,the menstrual volume scores of HIFU+TBEA group at 1,3 and 6 months after treatment were statistically significant differences(P<0.05).4.Compared with before treatment,dysmenorrhea scores of 1,3 and 6months after treatment were decreased in both groups,with statistically significant differences(P<0.05).Compared with HIFU group alone,the dysmenorrhea scores of HIFU+TBEA group at 1,3and 6 months after treatment were no statistically significant difference(P>0.05).5.Compared with before treatment,the uterine volume of HIFU+TBEA group and HIFU group alone decreased significantly after treatment,all P<0.05,showing statistically significant differences.Compared with HIFU group alone,the uterine volume of HIFU+TBEA group at 6 months after treatment was significantly different(P<0.05).6.Compared with before treatment,the hemoglobin level of HIFU+TBEA group and HIFU group alone increased after treatment,all P<0.05,with statistically significant differences.Compared with HIFU group alone,the hemoglobin level of HIFU+TBEA group at 1 month,3 months and 6 months after treatment was statistically significant,P<0.05.Conclusion:HIFU ablation technique combined with TBEA is safe and effective in the treatment of adenomyosis.Compared with HIFU ablation alone,it can significantly improve the efficacy of abnormal uterine bleeding caused by adenomyosis,reduce uterine volume more effectively and improve hemoglobin level.The dysmenorrhea scores of 1,3 and 6 months after treatment were compared between the two groups,and there was no statistically significant difference,but the cure rate and effective rate of dysmenorrhea in the study group were higher than those in the control group. |
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