| Background:Adenomyosis is a common benign gynecological disease characterized by the invasion of endometrial glands and stroma into myometrium. Patients with adenomyosis often report menorrhagia and dysmenorrhea, and even anemia. Hysterectomy and drugs are the main treatment options for patients with adenomyosis traditionally,but the patient’s quality of life is affected seriously by poor effect of drugs and big trauma of surgical treatment.The uterus plays a very important role to maintain women’s dignity and self-confidence, the micro-invasive and noninvasive treatment for adenomyosis with retaining the uterus is worthy of researching.As a non-surgical technique,HIFU is now widely used in therapy of various entities of benign and malignant tumor.Recently,HIFU has also been used in treating adenomyosis.its safety and effectiveness has been recognized.However,in clinical practice, we found some cases are difficult to treat.Whether all of the patients are suitable for HIFU treatment? The purpose of this study was to explore the relationship between the non-perfused volume ratio and the related factors in the application of HIFU treatment of adenomyosis to provide evidences for optimizing HIFU treatment.Objective:1. To explore the influencing factors related to the NPV ratio of HIFU treatment for adenomyosis to provide evidence for optimizing indications of HIFU treatment, and at the same time, to optimize treatment plan to increase the NPV ratio.2. To explore whether the incidence of adverse events related to treatment between the two groups with different NPV ratio has statistical difference.Methods:Between April 2013 and December 2014, a total of 93 patients with adenomyosis received HIFU under conscious sedation in Suining central hospital of Sichuan. The relationship between the influencing factors and NPV ratio was analyzed. The NPV ratio of the adenomyotic lesion was calculated based on the one day post-HIFU contrast-enhanced MRI, and the patients were classified as three groups:a group with NPV ratio> 50%, and a group with NPV ratio<50%, as well as the group with NPV ratio=0.We compared the age, abdominal wall thickness, scars in the acoustic channel of abdominal wall, the thickness of the lesion, uterine position, lesion location, lesion type, MRI signal intensity of lesion, average power of treatment and strength of treatment among the three groups. Adverse effects were recorded.Results:1. The non-perfused area was observed in all lesions. The NPV ratio> 50% was seen in 83% of the lesions, the NPV ratio≤50% was observed in 17% of the lesions. The average ablation rate was (65.28±23.94)%.2. The results showed that the location of the adenomyotic lesion and the MRI enhancement signal intensity of the lesion related to the NPV ratio (P<0.05).3. No significant difference was not observed in the incidence of adverse events between the two groups (P>0.05).Conclusions:1. The location of the adenomyotic lesions and the enhanced signal intensity of on contrast enhanced MRI are two factors that realtaed to the NPV ratio.2. Compared with the lesions located at the posterior wall and the fundus of the uterus, the lesions located at the anterior wall of the uterus is easier to treat with HIFU.3. The lesions with rich blood supply is more difficult to treat, but the NPV ratio could be increased by optimizing the treatment plan.4. There is no statistical difference between the two groups with different NPV ratio in incidence of intraoperative and postoperative adverse events. |
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