Clinical Research Of Laparoscopic Adenomyosis Lesion Resection

Objective:Adenomyosis is a common disease in women of childbearing age,and itis characterized by more and more young patients,many patients is necessary to treatdiseases but also to preserve fertility,to the lesions relatively limited adenomyosis,thelesion resection can achieve treatment purposes, and meet the patients reserved uterusrequirements.With the technological level of laparoscopic surgery laparoscopy is moreand more used in the treatment of gynecological tumors,compared to traditional opensurgery, laparoscopic surgery is shorter time,faster recovery of bowel function and lessinjury.In this paper,we observe the clinical effect of laparoscopic adenomyosis lesionresection in the treatment of adenomyosis,explore the use of laparoscopic adenomyosisexcision treatment of adenomyosis.Methods:A total of53patients with adenomyosis are treated by laparoscopicadenomyosis excision surgery at Da lian Maternity Hospital from March2007to April2011. We collect and collate the patient’s general clinical data and surgical treatment,collect the data of patient’s menstrual cycle,menstrual days, menstrual flow,dysmenorrhea (pain visual analogue scale VAS score), hemoglobin,uterine volume,in3months,12months and24months after surgery,by out-patient appointments andtelephone follow-up. Comparing the indicators of change of the patients after surgery indifferent periods and master the pregnancy outcomes and recurrence,and analysis thefactors affecting postoperative pregnancy and recurrence.Results:1.The mean age of the53patients underwent laparoscopic adenomyosislesion resection is (34.1±5),85%Patients are with the most common clinicalmanifestations of dysmenorrheal, followed by it is menstrual abnormalities, the ratiowas32.1%,28.3%patients are with anemia.2.53patients who underwent laparoscopic adenomyosis lesion resection surgeryhad no complications, The operative time is45-120min,the average is (70.4±21.3)min, blood loss is10-250ml,the average is (70.1±51.0) ml, patients after recovery well, postoperative morbidity rate is9.4%, postoperative morbidity rate is9.4%,postoperative fever temperature is （38.17±0.31）℃, body temperatures return tonormal3d after antibiotic therapy, patients discharge from hospital3-6days aftersurgery,7patients with peritoneal endometriosis have an operation on endometriosislesions electrocoagulation ablation surgery simultaneously;11patients with uterinefibroids have an operation on myomectomy;12patients have postoperative (GnRH-a) treatment for3-6months.3. Patients have a significant reduction in menstrual flow,3months after surgery,menstrual flow is (71.3±2.1)%,12months after surgery, menstrual flow is（73.6±4.7）%,24months after surgery, menstrual flow is （80.4±4.9）%, thedifference is statistically significant（P＜0.05）;3,12,24months after surgery, themenstrual cycle is （28.2±2.4）d、（27.7±5.5）d、（28.6±4.6）d, compared with thepreoperative menstrual cycle(29.1±4.1) d, the difference is not statisticallysignificant（P＞0.05）; before surgery the menstrual period (7.0±2.0) d haveno changes in the postoperative follow-up period（P＞0.05）.4. VAS score (1.9±0.8)3surgery after months, VAS score （2.1±1.2）12surgery after months, VAS score （3.7±0.5）24surgery after months, comparedwith the preoperative (5.3±2.4), the difference is statistically significant（P＜0.05）;VAS score24months after surgery are heigher than the score3month and12monthafter surgery, the difference is statistically significant（P＜0.05）.5. After3months,12months, and24months,the hemoglobin of15patients withanemia is （120.1±7.6）g/l、（121.7±4.1）g/l、（125.1±5.6）g/l, compared with thepreoperative （104.2±10.3）g/l, the difference is statistically significant（P＜0.05）;postoperative uterine volume is significantly reduced, preoperative uterine volume is（115.1±32.2）cm3, after3,12,24months uterine volume is (77.3±8.3) cm3,(75±8.3) cm3(80.5±10.6) cm3, the difference is statistically significant（P＜0.05）.6. Postoperative pregnancy rate of fertility requirements18patients is61.1%, theare natural pregnancy; pregnancy time is11-31months after surgery; the rate is5.6%inthe12months after surgery,the rate is38.9%in the12-24months after surgery,the rate is16.7%beyond the24months after surgery;5cases of11patients takecesarean section,1case have vaginal delivery,1patient with breech premature rupture of membranes and preterm take cesarean section; two cases of early pregnancy havespontaneous abortion, the rest2are the second trimester of pregnancy and the thirdtrimester of pregnancy, all patients do not uterine rupture during the pregnancy.7. Merger endometriosis pregnancy outcomes in patients is different, thepregnancy rate of patients uncombined with endometriosis is (76.9%) which issignificantly higher than the pregnancy rate of combined with endometriosis patients(20%), the difference was statistically significan（tP＜0.05）; the patient’s age, VAS score,preoperative uterine volume, having history of induced abortion or not, using of GnRH-aor not, a merger of uterine fibroids, the adenomyoma single or multiple, having history ofinfertility has nothing to do with pregnancy outcome （P＞0.05）.8. Patients are followed up for24-40months,5patients’ recurrence rate was9.4%,the first symptom of recurrence is dysmenorrheal, recurrence turn up after surgery(29.6±4.2) months, the patient’s age is (31.6±5.2) which is lower than the age ofpatients without recurrence (35.1±6.4), the difference is statistically significant（P＜0.05）; the preoperative uterine volume of recurrent patients is (146.8±16.5)cm3,which is significantly greater than patients without recurrence (113.3±28.1)cm3, the difference is statistically significant（P＜0.05）; preoperative VAS score, thepresence or absence of a history of abortion, parity, whether the merger endometriosisor uterine fibroids, single or multiple adenomyoma, using of GnRH-a postoperativeor not,are not associated with pregnancy and recurrence.Conclusions: Laparoscopic treatment of adenomyosis is shorter operative time,lessblood loss,faster recovery of bowel function and good recovered treatment effect;Laparoscopic uterine adenomyosis lesion resection is feasible and safe treatment,itretain reproductive function and can effectively relieve dysmenorrheal, menorrhagia,anemia and other symptoms,promote pregnancy after surgery; Pregnancy is safe in12-24months after surgery. The pregnancy rate of patients accompanied byendometriosis are lower; The younger and with greater the volume of preoperativeuterine patients are more likely to relapse;It is not sure to the function of using GnRH-aafter surgery to pregnancy and recurrence.