Clinical Efficacy Of Radiofrequency Ablation For Adenomyosis

Part One Clinical efficacy of ultrasound-guided transabdominal radiofrequency ablation for adenomyosisBackground and Objective Adenomyosis is a common gynecological disease prevalent in women of reproductive age. It has great impact on patients'normal life and work. Now we are searching a way of minimally invasive therapy. Our study investigated the feasibility, safety and short-term efficacy of ultrasound- guided transabdominal RFA for adenomyosis.Methods Thirty-two patients with adenomyosis in the first affiliated hospital of the Fourth Military Medical University were followed up at 1,3,6,10 months after RFA procedures. Menstrual history, childbearing history and miscarriage history were recorded before RFA procedures. Clinical symptom such as menorrhalgia, volume of menstrual blood and days of menstruation were recorded. The effective rate of clinical symptoms and complications were evaluated by descriptive method. The changes of days of menstruation, serum- CA125 and Hb level were analyzed by Student's t-test.Results The patients were followed up at 1, 3, 6 and 10 month after treatment. Clinical symptoms including menorrhalgia and volume of menstrual improved significantly at all follow-up time point. And days of menstruation shortened (P<0.05).Effective rate of symptoms improvement was 72%, and 80%, respectively. And clinical effective power is 87.5%. During follow-up, 28 patients(87.5%)show up transient bellyache, 30 patients (93.7%) had small pink vaginal secretions, 5 patients (15.6%) had postop anesthesia reaction, and 1 patient (13.1%) had low-grade fever. None of the severe complications was observed. One month after treatment CA125 level was significantly decreased, while Hb level was significantly increased compared with preoperative time (P<0.05).Conclusions Ultrasound-guided transabdominal RFA is a safety and technically feasible treatment for adenomyosis. Advantages of RFA in the treatment of adenomyosis include short time of therapy, short time to become effective, reproducibility and to assure the safety of female internal genital organs. As a newly developed therapy, it promised further research in the future. Part two Evaluative method of short-term efficacy of ultrasound-guided transabdominal radiofrequency ablation for adenomyosisObjective Clinical symptoms are key index to evaluate the efficacy of RFA therapy in gynecological diseases at present. However, a lot of factors have effect on clinical symptoms reported by patients. Thus, it is very important to establish a evaluation system with much accuracy and objection. In this study, the evaluative value of ultrasonography for RFA treatment in adenomyosis was investigated emphatically.Methods Thirty-two patients with adenomyosis in the first affiliated hospital of the Fourth Military Medical University were followed up at 1,3,6,10 months after RFA procedures. All patiernts were investigated with 2DUS, CDFI and CEUS before and after RFA treatment. The changes of Uterine volume by Student's t-test,and ablation area of uterus investigated by 2DUS,CDFI or CEUS were compared.Results (1)Befor RFA treatment, 2DUS image displayed that uterus were increscent , line of endometria had excursion, echo of focal zone emerged maldistribution, boundary of 14 patients'local focus could be distinguish.Ten months after RFA treatment, 2DUS image displayed that the echo of ablation area have been enhanced in 32 patients. And uterine volume had gradually grown down (P<0.01). (2)CDFI displayed that blood flow of 18 widespread focus in myometrium were affluent befor treatment. There were not blood flow in periphery of 14 local focus, those of inside were arborization or nematoid shape. After RFA, the blood flow in focal zone disappeared in 29(90.63%) cases. Three cases had remaining blood flow, decreased than preoperative state. (3)Compared with those before treatment, CEUS displayed that constrast medium were not observed in ablation areas after treatment.Conclusions Compare with 2DUS and CDFI, CEUS can reflect the remaining ablation areas and blood flow is with a much more direct and accurate way. Thus, we recommend that CEUS should be combined to evaluate the therapeutic efficacy after RFA treatment for adenomyosis.