| Adenomyosis is a kind of common disease which is affecting the health of women, characterized by the invasion ofendometrial glands and stroma into the myometrium, mainly for the progressive dysmenorrhea, menorrhagia, and anemia due to menorrhagia, Develops in women of childbearing age. Now the fundamental treatment is hysterectomy mainly, but now more and more patients required to retain the uterus and select conservative therapy, High Intensity Focused Ultrasound(HIFU) as a method of conservative treatment has been widely concerned, high intensity focused ultrasound can take advantage of characteristics of ultrasonic whice can penetrate human tissue and aggregate, concentrated the energy to the tumor, achieve instant high temperature(60-100 degrees C), so that the target tissue can occur coagulation necrosis and loss activity, so as to achieve the goal of treatment, and the lesions organizations outside the region without damage. HIFU treatment because of its non-invasive, less pain and rapid recovery after operation and other advantages, has attracted more and more attention in the clinical application, also is using more and more widely, the treatment time for the lesion size, hardness, flow conditions and other aspects of the impact, the treatment of adenomyosis generally in 1 to 2 hours, But in the course of treatment found some patients can not tolerate a long time treatment process due to the poor effect of treatment, also found that after treatment some patients’ symptoms recurren of ease, but recurrent once again, how to shorten treatment time and reduce recurrence has become the focus of our attention, this study intends to analyze the clinical symptoms of the patients who treated by HIFU, to observe the therapeutic effect of HIFU, and to observe the effection on the treatment duration of HIFU with injecting absolute alcohol through cavity guided by ultrasound and the influence of mirena.Objective: 1 To analyse the effect of HIFU in adenomyosis retrospectively; 2 To explore the effect of injection of absolute alcohol for the treatment time through the analysis and comparison the treatment time and the total energy of with and without injecting absolute alcohol through cavity guided by ultrasound; 3 To explore the effect of Mirena placed after the HIFU treatment.Methods: A retrospective analysis from July 2012 to December 2014 in Haifu treatment center of The second hospital of Hebei Medical University for 121 cases of adenomyosis of uterus, observed the follow-up results consecutively after the treatment, in the 3, 6, 12 months, evaluated the treatment results of HIFU in adenomyosis, including the changes of ultrasonic image and the improvement of the clinical symptom, further analyzed the cases of combined application of absolute alcohol and Mirena, evaluated the influence on the treatment time of injection of absolute alcohol and the effect of the Mirena.Results:1 Clinical data of adenomyosis patients before HIFU treatment : In 121 patients with adenomyosis 19-49 year old, average 37 years old, 93% patients had the history of pregnancy, times of pregnancy in the 1-5 times, while 7% of the patients had no pregnancy.The clinical symptoms of the patients are mainly dysmenorrhea and menorrhagia, 90% of the patients presenting with different degrees of dysmenorrhea, mainly with severe dysmenorrheal assessed by VRS score, according to the method of PBAC estimation of menstruation, menstrual score >100 is excessive menstrual, results showed that 69% of patients with menorrhagia,according to hemoglobin results 38% patients suffer from anemia, among which 5 people suffer from severe anemia; 2 HIFU treatment process observation: 121 patients were successfully completed treatment, without the occurrence of skin and soft tissue injury, nerve injury and intestinal injury; 3 The follow-up survey of adenomyosis patients After the treatment of HIFU :.Statistical observation will do at 4 time point when before treatment, after treatment on 3 month, 6 months and 12 months, the overall observation results show that : 3.1 The change of uterine size on ultrasound imaging: assessing the uterine size by the size of the uterus, the median of the uterine volume was 228.23cm3 before treatment, 12 months after treatment the median of uterine volume was 135.54 cm3, the decrease of the uterine volume median in 4 time point has statistical significance with using and not using Mirena in patients, P<0.05; 3.2 Changes of dysmenorrhea scores: The median of dysmenorrhea score is 3 before treatment, after the treatment of 3 months to 1 digits, and after 12 months to 0 digits, dysmenorrhea obviously reduced, P<0.05, with statistical significance; 3.3 Changes of menstrual quantity score:The median of menstrual quantity score is 110 before treatment, after 3 months of treatment to 90, after 12 months of treatment to 70, menstrual quantity decreased significantly, P<0.05, with statistical significance; 4 HIFU combined with absolute alcohol treatment at the time of treatment and comparison results of total energy use: There are 68 patients treated with absolute alcohol,The median of the treatment time in non combined treatment group is 519 seconds, in combined with absolute alcohol treatment group is 477 seconds, there was a significant difference between the two, The median of the total energy in non combined treatment group is 233600 joules, in combined treatment group is 198175 joules, both have statistical significance difference; 5 Effects of using Mirena after HIFU treatment: In 121 patients there are 28 cases using Mirena after HIFU, through analysing the situation of the 4 time point when before treatment, after treatment for 3 months, 6 months and 12 months can obtain that: there are statistically significant on the size of the uterus, reducing dysmenorrhea score and menstrual quantity score, but compared with the control group, there is no statistical significance on the effect,P>0.05.So using Mirena after HIFU treatment had no obvious effect on clinical effect within 12 months.Conclusions:1 High intensity focused ultrasound in treatment of uterine adenomyosis is safe and effective;2 Combined with absolute alcohol injection can shorten treatment time and reduce the treatment side reaction;3 There are no significant effect of using Mirena after HIFU treatment on the results, But small number of cases may not reflect the clinical effect, further observation is needed, the impact on long-term also needs further observation. |
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