Clinical Analysis Of Cytoreductive Surgery Of Adenomyosis:Adenomyomectomy Versus V-type Excision Of The Uterus

Objective:Adenomyosis is benign gynecologic condition in which endometrial glands and stoma invade the myometrium, causing myometrial inflammation and hypertrophy. The adenomyosis grows limited or diffused. The incidence of the disease shows a rising trend in recent years. The mechanism of adenomyosis is unclear yet, but the clinical symptoms of the disease have already affect the patient’s life and work. Meanwhile, the unfertility following the disease is troubling the the young patients. Over the years, the surgeons have been trying their best to find the best treatment options. This article discusses mainly about the efficacy of two cytoreductive suigical types:the adenomyomectomy and V-type excision of the uterus.Methods:A total of303patients were selected as study objects who suffered adenomyosis and underwent the adenomyomectomy or V-type excision of the uterus in the hospital from March2006to September2012. The postoperative pathology confirmed the diagnosis of adenomyosis. The patients were followed up regularly. We then studied the clinical efficacy of these two kinds of surgical methods, concluding the operation time, hemorrhage, postoperative hospitalization period. About each surgical method, we evaluated the changes of menstrual flow, dysmenorrhea, second-surgery and the impacts on pregnancy were researched.Results:The group that the patient had the adenomyomectomy consist of213cases, among which there were81(38%) cases complicated by menorrhagia. After operation, the volume of menstrual flow of75patients was significantly reduced, but the change of volume of menstrual flow of6patients was not obvious. There were10cases that the volume of menstrual flow was significantly reduced after operation but once again increased ranging from3-12month. There were151(70.9%) cases complicated by dysmenorrheal. The obvious remission rate of dysmenorrhea at one, three, and six months, one, two, three or beyond three years after operation were92.1%,88.1%,83.4%,76.2%,69.4%,58.3%. The number of recrudesced patient of dysmenorrhea at three, and six months, one, two, three or beyond three years after operation were4cases,5cases,8cases,7cases,10cases, and the rate of recurrence was22.5%. On the other hand,12cases had a second operation because of the unbearable dysmenorrhea symptom, and the rate of second operation was7.9%. There were28cases complicated by infertility, and after operation, a total of18cases had a successful fertilization, in which concluding15barren cases. Among the18cases,11cases had a successful delivery,2cases were in the state of pregnancy and5cases had an abortion. The rate of successful fertilization after operation among all the patients was8.45%. But among the barren cases, the rate was53.6%. The mean age of the patients that had a successful fertilization was statistically significantly younger than the age of all the patients(P<0.05). After operation,17cases had the symptom of menopause, accounting for7.98%of all patients.The group that the patient had the V-type excision of the uterus consist of90cases, among which there were53(58.9%) cases complicated by menorrhagia.. After operation, the volume of menstrual flow of all the53cases was significantly reduced. There were4cases that the volume of menstrual flow was significantly reduced after operation but once again increased ranging from4-9month. There were72(80%) cases complicated by dysmenorrheal. The number of recrudesced patient of dysmenorrhea was6cases till now and the rate of recurrence was8.0%and no one had a second operation because of the unbearable dysmenorrhea symptom. There was no no complicated by infertility, and after operation, nobody had a successful fertilization. After operation,8cases had the symptom of menopause, accounting for 8.89%of all patients.The comparison of the duration of the operation, the amount of bleeding in operation, the days in hospital after operation, the uterine size before operation of the two groups had no significant statistically difference(p>0.05). The comparison of the average age of patients of each group that had the symptom of menopause after operation with the average age of the group had no significant statistically difference(p>0.05).Conclusion:Both adenomyomectomy and V-type excision of the uterus had an obvious therapeutic effect for the symptoms of menorrhagia and dysmenorrhea in a short time. In the group that had the surgery of adenomyomectomy, with the extension of time, the remission rate was decreased gradually along with the increase of the recurrence rate. And the rate of second operation was increased. But in the group that had the surgery of V-type excision of the uterus, the remission rate was not decreased obvious with the extension of time. The recurrence rate was low and nobody had a second surgery. For the patient that had a complication of infertility, the surgery of adenomyomectomy could effectively improve the rate of pregnancy, but the surgery of V-type excision of the uterus had no help. So for the young patients or had a requirement of reproductive, the surgery of adenomyomectomy could be the first choise. For the patient that had no requirement of reproductive but had the demanding to reserve uterus, the surgery of V-type excision of the uterus was a good choise.