| Objective:To investigate the clinical effect of in patient with diffuse and focal adenomyosis treated by high intensity focused ultrasound(HIFU)ablation combined with gonadotropin-releasing hormone agonist(Gn RH-A)and levonorgestrel-releasing intrauterine system(LNG-IUS).Method:A retrospective analysis was performed on 136 patients with adenomyosis who received HIFU treatment in the Chenzhou First People’s Hospital from February 2018 to April 2019,including 97patients in the diffuse adenomyosis group(group D)and 39 patients in the focal adenomyosis group(group F).Group D and Group F were divided into four groups according to the various adjuvant therapies received after HIFU.D1/F1 group:HIFU alone group,D2/F2 group:HIFU+Gn RH-a treatment group,D3/F3 group:HIFU+LNG-IUS treatment group,and D4/F4 group:HIFU+Gn RH-a+LNG-IUS treatment group.The ablation rate and the improvement of dysmenorrhea and menstrual volume at 3,6,and 12 months after operation were observed.Results:All 136 patients completed HIFU treatment.The irradiation time of group D and group F were 505.53±261.21s,60.16±48.61cm3.And non-perfusion zone volume of group D and group F520.80±262.74s,51.35±40.67cm~3.There are no significant difference which were observed between two groups(all P>0.05).Group D and Group F’s ablation rates were:71.71%±22.84%,83.68%±20.80%,were observed among the two groups(P<0.05).VAS scores of dysmenorrhea of group D at 3,6,and 12 months after surgery were 2.22±1.39,2.24±1.41,and2.58±1.66,which were all lower than those before surgery 6.75±1.35(P<0.05).No significant difference was observed between the three groups in each of the two groups at three time periods(P>0.05).Menstrual volume scores of group D at 3,6,and 12 months after surgery were 1.33±0.67,1.52±0.69,1.53±0.77,which were all lower than those before surgery 3.54±0.66(P<0.05).No significant difference was observed between the three groups in each of the two groups at three time periods(P>0.05).VAS score of dysmenorrhea in group F at three postoperative periods were 2.08±0.93,2.39±0.99,and 1.97±1.31,which were all lower than those before surgery 6.77±1.44(P<0.05).No significant difference was observed between the three groups in each of the two groups at three time periods(P>0.05).Menstrual volume scores in group F at three postoperative periods were 1.28±0.60,1.39±0.59,1.56±0.72,which were all lower than those before surgery 3.51±0.72(P<0.05).No significant difference was observed between the three groups in each of the two groups at three time periods(P>0.05).Comparison of efficacy between group D and F:preoperative dysmenorrhea VAS score and menstrual volume score of group D and F were 6.75±1.35 and 6.77±1.44(P>0.05),respectively;3.54±0.66 and3.51±0.72(P>0.05).At 3,6,and 12 months after the operation,the effective rates of dysmenorrhea symptom improvement in group D were92.28%,88.7%,and 79.4%.The F group’s effective rates of dysmenorrhea improvement were 97.4%,92.3%,and 94.9%.There was no significant difference in the effective rate of dysmenorrhea improvement between group D and group F at 3 and 6 months after the operation.The effective rate of dysmenorrhea improvement in group F at 12 months after operation(94.9%)was better than that in group D(79.4%)(P<0.05).At 3,6,and 12 months after the operation,the effective rate of menstrual volume improvement in group D was 88.7%,86.6%,and 82.5%.The F group’s effective rate of menstrual volume improvement was 92.3%,92.3%,and 87.2%.There was no significant difference in the effective rate of menstrual volume improvement between group D and group F at 3,6,and 12 months after operation(P>0.05).No significant difference was observed between group D and group F at 3,6,and 12 months after operation(all P>0.05).Comparison of dysmenorrhea improvement in group D and group F receiving the same treatment at 12 months after surgery:the improvement rates of dysmenorrhea in group D and group F were D1(62.9%)/F1(93.3%),D2(83.3%)/F2(90.0%),D3(85.7%)/F3(100%),and D4(93.5%)/F4(100%).There were observed between D1group(62.9%)and F1 group(93.3%)(P<0.05),but no significant difference between the other three groups(P>0.05).The improvement rates of menstrual volume 12 months after surgery were as follows:D1(68.6%)/F1(73.3%),D2(83.3%)/F2(90.0%),D3(85.7%)/F3(100%),D4(96.8%)/F4(100%);No significant difference between the other three groups(P>0.05).The therapeutic effect of 136 patients at12 months was observed:the effective rates of dysmenorrhea in HIFU alone,HIFU combined with Gn RH-a,HIFU combined with LNG-IUS,HIFU combined with Gn RH-a,and LNG-IUS were 72%,85.3%,91.7%,and 95%.The improvement rates of menstrual volume were 70%,85.3%,91.7%and 97.5%.HIFU combined with Gn RH-a and LNG-IUS treatment was superior to HIFU alone in both dysmenorrhea and menstrual volume improvement(P<0.05).There was no significant difference in the improvement rate of dysmenorrhea and menstrual volume between any two groups in other groups(P>0.05).The recurrence rate in this study was 2.9%.One patient was from the F2 group,Three patients were from group D,of which two patients were treated with HIFU combined with Gn RH-a;One patient was treated with HIFU combined with Gn RH-a and LNG-IUS.Among the patients,2 cases of increased menstrual volume and two cases of dysmenorrhea recurred.Conclusion:1.HIFU is effective in treating both diffuse and localized adenomyosis,but localized adenomyosis is superior to diffuse adenomyosis;2.Combined with Gn RH-a and LNG-IUS,HIFU can improve the efficacy in the treatment of different types of adenomyosis. |
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