Application Of High Intensity Focused Ultrasound Combined With Mirena In Treatment Of Adenomyosis

Background:Adenomyosis is one of the commonest clinical diseases, which leads to dysmenorrhea, hypermenorrhea and menostaxis. Progressive dysmenorrhea is the main clinical symptom. However, there are few safe and effective methods. Take drug treatment for example, it can cause serious side effects and can not be used in the long term. Researchers have been searching for new methods, including focus clearance, uterine artery embolization, High Intensity Focused Ultrasound (HIFU) and levonorgestre releasing intrauterine system(LNG - IUS). HIFU is a brand new noninvasive technique which can focus low energy ultrasonic to vivo lesions and results in tissue necrosis. The technology can ablation adenomyotic foci, relieve symptoms, retain uterus. Thus, HIFU is applied in the treatment of adenomyosis in recent years, but some patients still suffer from dysmennorrhea after the treatment. LNG-IUS is the combination of IUD (Intrauterine Device) and OCP (Oral Contraceptive). It has clinical contraception effects, meanwhile, it can inhibit the ectopic endomrtrium’s hyperplastic and the endometrium becomes thinner. Clinical study shows that it can relieve symptoms caused by adenomyosis, but it does not show obvious effects on the reduction of uterine size. Therefore, a better treatment protocol, which is expected to reduce the size of uterine and relieve dysmennorrhea more effectively, is needed.Objectives:1. Compare the clinical efficacy of HIFU and HIFU combined with LNG-IUS in the treatment of adenomyosis.2. Observe the complications of adenomyosis treated by HIFU combined with LNG-IUS and evaluate the safety.Methods:1. Collect 40 patients with adenomyosis who have failed in drug treatments. Divide them into 2 groups at random, the HIFU group and the HIFU combined with LNG-IUS group, with 20 patients in each group. The two groups of patients were evaluated before treatment and in the 2nd,3rd, 6th month respectively after treatment and the evaluations included visual analogue scale (VAS), plasma substance P levels, uterine size changes and adverse reactions in the follow-up.2. Analyze all the results above and compare the efficacy and safety of the two groups.Results:1. Safety comparison:All the 40 patients have no adverse reactions in the treatment by HIFU and placing LNG-IUS.40 patients have been followed up in 6 months. In HIFU group,3 patients (15%) have vaginal irregular bleeding and 1 patient (5%) suffers from sacral distending pain, while in the combined group,4 patients (20%) have vaginal irregular bleeding. All the adverse reactions above were relieved or disappeared.2. Efficacy comparison:2.1. Pain score comparison:a. The scores of VAS given by patients in HIFU group declined to 3.63±1.05 in the 2nd month after treatment from 7.58±1.21 before treatment, which has statistical significance (P<0.05). Dysmenorrhoea in 16 patients (80%) were relieved obviously and that in 10 of them disappeared. The scores of VAS in the 3rd month decreased to 2.30 ±1.00, which has significant differences (P<0.01).12 patients in total had no dysmenorrhoea any more and the score of VAS decreased significantly (P<0.01). The scores in the 6th month remained stable, b. In HIFU combined with LNG-IUS group, the scores of VAS declined to 2.46 ±0.82 in the 2nd month after treatment from 7.56±1.02 before treatment, which has statistical significance (P<0.01). Dysmenorrhoea in 17 patients (85%) were relieved obviously and that in 14 of them disappeared. The scores of VAS in the 3rd month and the 6th month remained stable. c. Dysmenorrhoea in the two groups were relieved or disappeared. The scores of VAS in HIFU group are higher than the combined group (P<0.05).2.2 Plasma substance comparison:Both two groups have obvious decline in the second month after treatment, which has statistical significance (P<0.05). Plasma substance P level stayed stable in the third and sixth month. It decreased more in the combined group than HIFU group.2.3 Comparison of uterine size changes:The uterine size of all the 40 patients became smaller in the third and sixth month after treatment. The minification was 28.6% and 35.4% in HIFU group, while it was 30.0%, 35.7% in the combined group. Compared with the size before treatment, the minification has statistical significance (P<0.05). The comparison of minification between the two groups has no statistical significance (P>0.05).Results:The HIFU combined with Mirena has more significant curative effect in the treatment of adenomyosis than using HIFU only. It is a safe and effective therapy for adenomyosis.