Clinical Studies On Ultrasound Guided Percutaneously Microwave Ablation For Adenomyosis

Purposes1.To evaluate the safety of ultrasound guided percutaneous microwave ablation (PMWA)for the treatment of symptomatic adenomyosis;2.To study the clinical improvements ofsymptomatic adenomyosis patients after the treatment of PMWA.Materials and Methods1. Safety: One hundred and eighty five symptomatic uterine adenomyosis patientsunderwent PMWA. Therapy related adverse reactions were recorded and evaluatedbased on the method built by the Society of Cardiovascular and InterventionalRadiology (SCVIR). Meanwhile the serum estradiol (E2) and follicle stimulatinghormone (FSH) of before and3,6,9,12months after ablation, as well as menstrualperiod, pregnancy, menopause were also recorded to assess the effecacy on ovarian andendometrium function.2. Effectiveness: Dysmenorrhea, uterine volume and the score of UFS-QOL wererecorded before and3,6,9,12months after PMWA, and the difference between diffuseand focal adenomyosis were also discussed. Meanwhile the changes of CA125and PRLbefore and3,6,9,12months after ablation were also used to evaluate ablation effect.Results1. Safety: After PMWA, most of the patients were in SCVIR A or B, one patient is C.Adverse reactions included: vaginal secretion, most of them were light pink anddisappearred within one month; one patient had bloody secretion and medium-gradefever after2days of treatment, and she readmitted to get treatments. Analgesic wereadministered for once to49.73%of the patients, and they recovered within6hours;14patients had fever after treatment,1was midium-grade fever, the other were low-grade; microscopic hematuria were detected in18patients within4hours after PMWA whichconsidered for the reason of catheterization and urine routine turn to normal after2-4days without any further treatment. The changes of E2and FSH in every follow-upstages have not show significant differences（p＞0.05）.23patients discharged necrotictissue naturally after1-12months of treatment. In trauterine adhesion was reported in1patient, menstrual turned to normal after adhesions decomposition.5patients conceived6times naturally,5times artificial abortion, and1in pregnancy.2. Effectiveness: The dysmenorrhea degree, uterine volume, hemoglobin in anemia onesand UFS-QOL were improved in each follow-up stage (p＜0.05). Compared diffuseadenomyosis with focal adenomyosis in these above subjects, there are no obvioussignificant differences (p＞0.05). CA125and PRL decreased significantly3,6,9and12months after ablation（p＜0.05）, and CA125has positive correlation to dysmenorrheaand uterine volume changes (correlation coefficient:0.374and0.440， p＜0.05). WhilePRL has not the correlation between these main symptoms (p＞0.05）；Meanwhile norelationship between of CA125and PRL (p＞0.05).Conclusions1. Safety:(1) There are no surrounding organs injury so far. While, to ensure the safetyof ablation, monitoring high echo range are necessary.(2) PMWA has no negativeeffects in ovarian function and endomertrium, patients may have the chance of conceive,but the influence is still uncertain.2. Effectiveness:(1) PMWA can relieve the main symptoms of adenomyosis andimprove living quality of patients.(2) PMWA has satistactory efficacy in the treatmentof both diffuse and focal adenomyosis.(3) The serum CA125and PRL declinedobviously after PMWA, the changes of CA125are related to uterine size anddysmenorrheal changes after ablation.