The Efficacy Of Uterosacral Nerve Ablation(UNA)in The Treatment Of Localized Adenomyoma

Objective:The aim of this work is to explore the efficacy, safety, and patients’ satisfaction of uterine nerve ablation (UNA) in relief of dysmenorrheal pain and dyspareunia and reducing the menorrhagia in women with localized adenomyoma.Methods:26patients,who were diagnosed localized adenomyoma in Qilu Hospital of Shandong University, between November2008and January2012, age range23-46years, mean age39.2years, were divided into two groups, including17cases in the control group (removing the focus of the disease without uterine nerve ablation) and9cases in the study group (removing the focus of the disease plus UNA). Operation with or without uterine nerve ablation was done and then followed up in1,3,6,12,18,24months to observe the treatment effect of the two groups. The evaluation index include the visual analogue scale (VAS) of dysmenorrheal, the reducing the menorrhagia, the relief of dyspareunia. At the end of the following-up, we calculated the satisfaction of all cases. The comparison between the two groups rate with Fisher accurate probability inspection, the comparison of the mean of two groups with the independent-t test sample, and while comparing with the preoperative situation in the group, use the matching t test. A level of p value<0.05was regarded as statistically significant.Results:There were no statistically significant difference between both groups regarding the pain relief in dysmenorrheal, between the study group and the control group, it was8.11±2.472and8.53±1.546respectively preoperative. It was2.50±0.577and2.44±1.236、2.33±0.577and2.20±1.643,2.33±0.577and2.20±1.643,4.00±2.646and2.67±2.081at1、3、6、12months respectively; P>0.05. Comparing with the preoperative situation, both groups had a great relief in dysmenorrheal, P<0.01. About the relief rate of dysmenorrheal, it was55.6%(5/9) and47.1%(8/17)、66.7%(6/9) and70.6%(12/17)、66.7%(6/9) and70.6(12/17)、66.7%(6/9) and82.4%(14/17)at1、3、6、12months, respectively, P>0.05. The preoperative menstrual blood volume was set in100±0.00, it was89.0±5.48and86.1±2.63,79.0±5.487and7.5±9.35、77.5±9.57and68.8±17.34, at1、3、6months, respectively, P>0.05. Both groups had a great reduce in the menorrhagia, P<0.05. About the dyspareunia, there was one case in the study group and it was relieved. There were five women suffering from dyspareunia in the control group, and two of five were relieved. The cumulative patients’satisfaction rate in the study group was77.8%(7/9) while that was82.4%(14/17) in the control group, P>0.05.Conclusion:UNA is not necessary for those patients who were diagnosed with localized adenomyoma while removing the focus of the disease. It did not increase the curative effect in treating this disease, comparing with the control group, in the relief of dysmenorrheal pain and dyspareunia and the reducing of menorrhagia and the cumulative satisfaction of patients.