Study On The Correlation Between Endometriosis And The Degree Of Dysmenorrhea Remission After HIFU Treatment Of Adenomyosis

Adenomyosis is a common gynecological disease in reproductive age womem. It is charactic of endometrium locates within myometrium of the uterus. Dysmenorrhea is one of the main clinical symptoms affecting the quality of life. The most common used treatments include conservative medical treatment, uterine artery embolization, adenomectomy or hysterectomy. High intensity focused ultrasound(HIFU) ablation is a novel noninvasive treatment and has been widely used in gynecological practice.Many studies have demonstrated that HIFU is safe and effective in the treatment of uterine firoids and adenomyosis.Adenomyosis is characteristic of endometrium located between the myometrium. Endometriosis is an often painful disorder in which endometrium grows outside of the uterus. It commonly involves ovaries,bowel or the tissue lining pelvis. Rarely, endometrial tissue may spread beyond the pelvic region. Pelvic pain was seen in 70% of the patients with endometriosis. Laparoscopy is the “gold standard” for diagnosis ofendometriosis, but it’s an invasive technique and not acceptable for the only purpose of diagnosis. Megnetic resonance imaging(MRI) is a non-invasive diagnostic modality and its sensitivity and specificity of diagnosis were higher than 90%, so it can be used for preoperative evaluation and diagnosis.In this study, we retrospectively analyzed 55 patients with adenomyosis who received HIFU ablation by comparing the degree of dysmenorrhea before and after HIFU to explore whether endometriosis affect HIFU ablation adenomyosis dysmenorrhea disease remission or not.Objective:1. To retrospectively investigate whether the dysmenorrhea relief after the HIFU ablation treatment of adenomyosis;2. To investigate the correlation between endometriosis and the degree of dysmenorrhea remission after HIFU ablation in the treatment of adenomyosis.Methods:Fifty-five patients with adenomyos who received HIFU from January2015 to July 2015 were retrospectively analyzed. The average age of the patients was 39.69 ± 5 years old(range: 28-53). Based on the results from MRI, patients were divided into three groups. Group A: 26 cases,adenomyosi without pelvic endomytriosis; Group B: 17 cases, adenomyosis with deep infiltrating endometriosis; Group C: 12 cases, adenomyosis withovarian endometriosis cyst. Age, CA125, HIFU ablation range, degree of dysmenorrhea afer HIFU ablation were compared.Results:In group A, complete relief was observed in 3 cases(11.54%), partial relief was seen in 20 cases(76.92%), no response was observed in 3 cases(11.54%); In group B, complete relief of pain was observed in 1 case(5.88%), partial relief was seen in 7 cases(41.76%), and 9 cases(52.94%)reported no change; In group C: partial relief was seen in 10 cases(83.33%), and 2 cases(16.67%) reported no change.We further compared the pre- and post-HIFU pain score in the three groups, the pain score was significantly decreased(P < 0.05).Age, CA125 value, adenomyosis volume, ablation rate no significant difference among the three groups(P> 0.05).Conclusion:1. After HIFU treatment, the pain score decreased in all the three groups of patients;2. The pain relief rate was significantly lower in the patients from group B(AM with DIE) than that of group A(AM without EM) and group C(AM with OEM). No significant difference was observed between group A(AM without EM) and group C(AM with OEM).