| Objective1. To study the symptom improvement and analyze the significant variables for dysmenorrhea alleviation degree of patients with adenomyosis after ultrasound-guided percutaneous microwave ablation (PMWA) therapy.2. To analyze the significant variables for vaginal discharge which is the most common side-effect after ultrasound-guided percutaneous microwave ablation (PMWA) therapy.Materials and methods1. Efficacy and related variables analysis:Patients from September 2012 to February 2015 who underwent PMWA treatment for adenomyosis were included. All patients were followed up for one year. Clinical symptoms, uterine volume and anemia improvement et al. were recorded 3 months,6 months,9 months and 12 months after treatment respectively. Patients with clinical effective symptom alleviation with complete clinical data were classified into G1 (symptoms alleviated completely), G2 (symptoms alleviated obviously), and G3 (symptoms alleviated partially) according to the alleviation degree of symptoms. The potentially correlative variables were analyzed. Variables with significant correlations with treatment efficacy post-ablation were identified via multinomial logistic regression analysis.2. Analysis for variables for vaginal discharge:PMWA was performed on patients with adenomyosis from October 2012 to July 2014. The presence or absence, color, quantity and duration of vaginal discharge, which was different from pre-ablation, were recorded within one year after PMWA. Patients were categorized into G1 (without vaginal discharge), G2 (vaginal discharge lasting 1 to 19 days) and G3 (vaginal discharge lasting ≥ 20 days) groups. The potentially correlative variables were analyzed. Variables with significant correlations with vaginal discharge post-ablation were identified via binary logistic regression analysis.Results1. Efficacy and related variables analysis:(1) Symptom alleviation condition:A total of 207 patients were included in the study. The dysmenorrhea score of patients before PMWA treatment was 7.07±1.9 points. The dysmenorrhea after PMWA treatment was alleviated to different degree. The clinical effective rate (symptoms alleviated completely + symptoms alleviated obviously + symptoms alleviated partially) 3 months, 6 months,9 months and 12 months after treatment were 92.45%(147/159),96.04% (97/101),89.39%(59/66), and 88.57%(62/70) respectively with clinical significant difference. The symptom severity score (SSS) and health-related quality of life (HRQL) of Uterine Fibroid Symptoms and Quality Of Life (UFS-QOL) questionnaire, uterine volume, hemoglobin level of anemia patients were all improved statistically significantly (p< 0.05). The cancer antigen 125 (CA125) level decreased significantly with statistical difference 3 months,6 months,9 months and 12 months post treatment (p = 0.000, p = 0.001, p = 0.002, and p = 0.006 respectively). (2) Variables for efficacy analysis:There patients with clinical alleviation were categorized into Gl (n = 43 of symptoms alleviated completely) G2 (n = 44 of symptoms alleviated obviously), and G3 (n = 33, symptoms alleviated partially). The difference of dysmenorrhea score before treatment, the HRQL score of the UFS-QOL questionnaire, and the ablation ratio between groups were statistical different (p = 0.000, p = 0.037 and p = 0.006 respectively). Further logistic regression results showed that ablation ratio was the significant variable for patients with complete symptom alleviation and obvious symptom alleviation [(odds ratio (OR) = 107.359, p = 0.002,95% CI:5.290-2178.967] and [(odds ratio (OR) = 21.624, p = 0.048,95% CI:1.021-457.815] comparing with patients with partial symptom alleviation. PMWA treatment could get obvious symptom alleviation for patients with severe dysmenorrhea [(odds ratio (OR) = 1.864, p = 0.001, 95% CI:1.274-2.727] comparing with patients with partial symptom alleviation.2. Analysis for variables for vaginal discharge:(1) Analysis of baseline characteristics: A total of 117 patients were included. There patients were categorized into Gl (n = 26, without vaginal discharge), G2 (n = 40, vaginal discharge lasting 1 to 19 days) and G3 (n = 51, vaginal discharge lasting≥ 20 days) groups. ① Analysis of variables of general clinical information:adenomyosis type differed significantly among groups (p = 0.005), No significant differences of other variables were observed among groups (p > 0.05). ② Analysis of lesion characteristics and microwave ablation relative parameters among groups:The among-group differences in pre-ablation uterine volume and minimum distance from the NPL margin to the EMJ were significant (p = 0.000 and p = 0.000, respectively). There was no significant difference in the rate of uterine volume shrinkage among groups (p = 0.503). The differences in total microwave ablation energy and total NPV among groups were significantly different (p = 0.000 and p = 0.005, respectively). (2) Logistic regression analysis:Significantly correlative variables (adenomyosis type, uterine volume pre-ablation, minimum distance of the NPL margin to the EMJ, total ablation energy, and total NPV 3 days post-ablation) were included in the logistic regression model. Minimum distance from the NPL margin to the EMJ was the strongest predictor of vaginal discharge post-ablation [odds ratio (OR) = 0.632, p = 0.018,95% CI:0.432-0.923]. Patients with diffuse adenomyosis were more likely to have prolonged vaginal discharge (> 20 days) post-ablation [odds ratio (OR)= 3.461, p = 0.000,95% CI:1.759-7.536].Conclusion1. Efficacy and related variables analysis:Adenomyosis patents after PMWA treatment could get definite effect with symptoms completely or obviously alleviated. Patients after PMWA could get satisfied efficacy for both diffuse and focal adenomyosis and get obvious symptom alleviation for patients with severe dysmenorrhea before treatment. Microwave ablation ratio was significantly associated with dysmenorrhea symptom alleviation degree post PMWA treatment2. Analysis for variables for vaginal discharge:Vaginal discharge is one of the most common side-effects post PMWA treatment. The minimum distance from the NPL margin to the EMJ and adenomyosis type were significantly associated with vaginal discharge post-ablation. |
PDF Full Text Request