The Medium To Long Term Clinical Outcomes Of Conservative Surgery On Adenomyomas Of72Cases

ObjectiveTo explore ideal treatment method for adenomyomas. Retrospective analysisof collected uterine adenomyoma patients who were treated by differentconservative surgical treatment method, in order to provide valuableinformation for uterine adenomyoma patients.MethodsThis was a retrospective study involving72cases of uterine adenomyomapatient at Qilu hospital and Affiliated hospital of Taishan Medical Collegebetween March2010and May2010. According to different treatment methods,these patients were divided into four groups, and followed-up by the samesurgeon through outpatient reexamination or telephone at1,3,6,12,18,24monthspostoperative, recording the change of clinical symptoms such as dysmenorrheal,menstrual blood volume, uterine volume, and serum CA125levels, checkingpelvic by bimanual examination or vagino-recto-abdominal examination. Andevaluate patients comfort and surgeon satisfaction at6,12,18months aftersurgery and at the end of follow-up.Results(1) the patient’s degree of dysmenorrhea, the reduction of uterine volumeand serum CA125levels, has declined and statistically significant whencompared with preoperative, but when compared between abdominal andlaparoscopic excision of adenomyosis, the difference has no statisticallysignificant between the two surgery methods(P＞0.05).(2)The group of laparoscopic excision of adenomyosis combination withlaparoscopic uterine nerve ablation(LUNA) compared with the group of laparoscopic excision of adenomyosis, the remission rate of dysmenorrheal,sexual pain, change of menstrual flow and surgical satisfaction, the difference intwo groups has no statistically significant (P＞0.05).(3) The patients who treated by laparoscopic adenomyosis excavationcombination with GnRH-a postoperative, compared with the patients whotreated only by laparoscopic adenomyosis excavation, the difference in someclinical symptoms such as dysmenorrhea score, menorrhagia standard and serumCA125levels has no statistically significant (P＞0.05).However, the differencein the level of hemoglobin values, uterine volume, the relief of symptom andpatient satisfaction has statistically significant (P＜0.05).Conclusion(1) Uterine adenomyoma patients’ dysmenorhea, menorrhagia, the reductionof uterine volume and serum CA125levels, all have significantly improved afterthe operation of abdominal or laparoscopic excision of adenomyosis.It meansthat local lesion resection is a good choice for uterine adenomyoma patients whowant to preserve reproductive function.(2) Compared with open surgery, Laparoscopic adenomyosis excavation hassimilar therapeutic effect. However, minimally invasive surgery has manyadvantages such as less trauma, quicker recovery and so on, it has developedinto a mature surgery in gynecological field, so it is an effective and safetreatment method to replace open surgery.(3) In theory, laparoscopic uterine nerve ablation (LUNA) can improvedysmenorrheal, chronic pelvic and other symptoms by blocking the pathway ofpain signals. However, in our study we found laparoscopic excision ofadenomyosis combination with LUNA does not increase therapeutic effect. Sowe have a conclusion that the improvement of uterine adenomyoma patientssymptoms is closely related to the extensive of the surgery rather than uterineneurectomy.(4) For symptomatic uterine adenomyoma patients, conservative surgery,regardless of whether using GnRH-a treatment, can obtain satisfactory clinicalresults. However, surgery combined with GnRH-a treatment than surgery alonecan be more effective in controlling symptoms and lower the recurrence rate ofsymptoms.