The Clinical Analysis On Treatment Of Adenomyosis With The Wall Of Uterus Less Than 3cm In Thickness By High Intensity Focused Ultrasound

Background:Adenomyosis is a disease with the endometrial glands and stroma etopic into myometrium.Adenomyosis is common in the above 40 years old woman.the patients showed menorrhagia,infertility and other clinical symptoms, serious impact on patients quality of life. The incidence of uterine adenomyosis rate rises year by year and more younger in recent years, the treatment of adenomyosis is hard and troubles the gynecologist and patients.The treatment methods of adenomyosis concludes drugs, levonorgestre releasing intrauterine system,resection, uterine artery embolization, transcervical resection of the endometrium and high intensity focused ultrasound (HIFU). Drug treatment mainly contains sex hormones, which can control the symptoms in the short term, but long-term use may cause the female endocrine disorders and liver damage, that is easy to relapse after drug withdrawal. Hysterectomy is the only possibility radical cure of adenomyosis,but is only for older patients with no fertility requirements.But hysterectomy may appears premature ovarian and destructs pelvic anatomical structure and other complications,even for patients with mental harm.HIFU is a noninvasive technique and can focus low energy ultrasonic to vivo lesions,leading to the deadly temperature in lesions,finally resulting in tissue necrosis. The technology can ablation adenomyotic foci, relieve symptoms, retain uterus.A large number of studies have shown the safety and efficacy of HIFU ablation the adenomyosis.But they only select the patients with the wall of uterus more than 3 cm in thickness.Some patients with the wall of uterus less than 3 cm in thickness still suffer menorrhagia,dysmennorrhea and other serious symptoms.These patients are no reaction to drugs and levonorgestre releasing intrauterine system but unwilling to hysterectomy.Therefore,it’s necessery to find a treatment with small trauma and good effect,HIFU is a promising method.However,the safety and efficay of HIFU ablation the adenomyosis with the wall of uterus less than 3 cm in thickness still need further research.Objective:1. To evaluate the clinical efficacy of HIFU ablation the adenomyosis with the wall of uterus less than 3 cm in thickness.2. To observe the complications of HIFU ablation the adenomyosis with the wall of uterus less than 3 cm in thickness and evaluate the safety.Methods:1.30 patients of adenomyosis with the wall of uterus less than 3 cm in thickness were treated by HIFU. ablation rate was calculated and efficacy was evaluated from the ultrasound image before and after HIFU.At 1,3,6 months after HIFU, the symptom score changes and lesion ultrasound imaging were followed up, symptom remission rate and reduce rate of lesions were calculated.2.The complications of HIFU ablation the adenomyosis with the wall of uterus less than 3 cm in thickness were recorded.The adverse reaction at 1,3,6 months after HIFU were analysised.Results:1.In all patients,16 (53.33%) emerged immediately mass of gray change after HIFU,14 (46.67%) had whole gray change. Contrast-enhanced ultrasound showed the lesions of inactivated region without contrast agent filling and no echo immediately after operation. The ablation rate was 23.29±99.14%, the average was (65.17±25.00)% immediately after HIFU treatment.2.At 1,3,6 months after HIFU,30,26,24 patients were followed up. Lower abdominal pain,backache,waist expansion,menorrhagia,menostaxis and other symptoms were relieved. The total efficiency of treatment respectively were 63.33%(19/30)、73.07%(19/26)、70.83%(17/24)3. At 1,3,6 months after HIFU,30,26,24 patients accepted ultrasound examination. Color Doppler showed the blood flow of lesions decreased or disappeared,the reduction ratio of lesions volume were respectively (32.32 ±22.85)%, (38.50±29.26)%, (41.53±26.47)%,the lesion volume before HIFU was (1.78±0.94) cm3, At 1,3,6 months after HIFU were separetely (1.29±0.72) cm3、(1.13±0.62) cm3、(1.01±0.39) cm3, Compared with the preoperative, the difference had statistical value (P< 0.05).4.30 patients had stable vital signs before and after treatment,the mtraoperative pain 2-4 score and all patients were tolerated. After HIFU,10 cases suffered lower abdominal discomfort,including 1 case accepted drug therpy for 1 weeks.1 case occurred sacrococcygesl pain ande had drug treatment for 1 weeks.1 case emerged lower limb pain and 5 cases vaginal secretion and didn’t give any special treatment.No case occurred skin injury, intestinal perforation, bladder,nerve damage and other serious complications.Conclusions:1. HIFU ablation the adenomyosis with the wall of uterus less than 3 cm in thickness is efficient. In the 6 months’ follow-up, the symptoms of adenomyosis were obviously alleviate,all lesions volume reduced than the treatment before.2. HIFU treatment of the adenomyosis with the wall of uterus less than 3 cm in thickness didn’t have more adverse reactions and serious complications.