| ObjectiveTo retrospectively analyze the differences in the mid-term efficacy of patients with four subtypes of adenomyosis based on the classification proposed by Kishi after focused ultrasound ablation surgery(FUAS),and to explore the guiding significance of the Kishi classification for FUAS in the treatment of adenomyosis.MethodsA total of 436 patients who were admitted to the gynecology department ofAffiliated Hospital of North Sichuan Medical College from January 2016 to January 2020 and were diagnosed with adenomyosis by pelvic magnetic resonance imaging(MRI)and underwent FUAS treatment were retrospectively analyzed.According to the Kishi classification,Type Ⅰ to Ⅳwere divided into group Ⅰ to Ⅳ.The dysmenorrhea score,menstrual volume score,hemoglobin(Hb)value,uterine volume and postoperative complications were compared among the four groups of patients before surgery and at 3,12,and 24 months after surgery.Dysmenorrhea was scored using visual analogue scale,and menstrual volume was scored using 5-level scoring method.The differences in the curative effect of the four groups of patients after FUAS treatment were analyzed.Results403 patients were successfully followed up,and 33 patients were lost to follow-up,including 137 patients in group Ⅰ,128 patients in group Ⅱ,63 patients in group Ⅲ,and 75 patients in group Ⅳ.1.Improvement of dysmenorrhea and menstrual volume:Compared with preoperative,the dysmenorrhea and menstrual volume scores of the four groups were significantly reduced at 3,12,and 24 months after operation,and the difference was statistically significant(P<0.05).The dysmenorrhea and menstrual volume scores of patients in group Ⅰ and Ⅲ shovved a continuous downward trend at each postoperative time point,while the postoperat.ive time points in groups Ⅱ and Ⅳ showed a downward trend at first,and then gradually increased,there was a significant upward trend at 24 months after operation compared with 3 and 12 months after operation,and the changes of dysmenorrhea and menstrual volume scores in each group with time were significantly different(P<0.01).At 24 months after operation,the dysmenorrhea and menstrual volume scores of group Ⅰ and Ⅲ were significantly lower than those of group Ⅱ and Ⅳ,and the differences were statistically significant(P<0.05).The total effective rates of dysmenorthea relief were 89.3%,86.6%,and 80.1%at 3,12,and 24 months after operation,and the total effective rates of menstrual volume improvementwere 85.1%,83.4%,and 76.4%at 3,12,and 24 months after operation,respectively.At 24 months after operation,the effective rates of dysmenorrhea relief and menstrual volume improvement in group Ⅰ and Ⅲ were significantly higher than those in group Ⅱ and Ⅳ,and the difference was statistically significant(P<0.008).There was no significant difference in the effective rates of dysmenorrhea relief and menstrual volume improvement between the groups at 3 and 12 months after operation(P>0.05).2.Changes of Hb value and uterine volume:Compared with preoperative,the Hb value of the four groups increased,and the uterine volume decreasedat 3,12,and 24 months after operation,and the difference was statistically significant(P<0.05).The Hb value of patients in groups Ⅰ andⅢ showed a continuous upward trend at each time point after operation,and the Hb value in groups Ⅱ and Ⅳ showed a trend of first increasing and then gradually decreasing at each time point after operation,but there was no significant difference in the change trend of Hb value with time among the groups(P>0.05).The uterine volume of patients in groups Ⅰ and Ⅲshowed a continuous decreasing trend at each time point after operation,while the uterine volume in groups Ⅱ and Ⅳ showed a decreasing trend at each time point after operation,and then gradually increased,but there was no significant difference in the change trend of uterine volume with time among the groups(P>0.05).3.FUAS treatment parameters:the non-perfused volume ratios of groupⅠ and Ⅲ were higher than those of group Ⅱ and Ⅳ,and the difference was statistically significant(P<0.01).4.Complications:No serious complications occurred in each group after operation,and the complications belonged to the Society of Interventional Radiology(SIR)-grade～B.Conclusion1.FUAS is safe and effective in the treatment of adenomyosis.2.The short-term efficacy of FUAS in the treatment of four subtypes of adenomyosis in Kishi classification is simitar,while the mid-term efficacy of type Ⅰ and type Ⅲ is better than that of type Ⅱ and type Ⅳ.P atients with type Ⅱ and type Ⅳ adenomyosis can be supplemented with other treatment methods after FUAS treatment,in order to obtain better curative effect.3.The Kishi classification is expected to be a predictive method for evaluating the prognosis of FUAS treatment of adenomyosis. |
