The Clinical Study Of HIFU Combined With PEI In The Treatment Of Uterine Adenomyosis

Background:Uterine adenomyosis is endometrial hyperplasia, the infiltrative growth of which is in myometrium and induces lesions. When lesions evolve into localized nodules, it calls adenomyoma. Women of reproduction age belong to population of high incidence, whose age are between 30-50 years old. The clinical manifestation of this disease mainly is progressive algomenorrhea, heavy menstrual bleeding, chronic pelvic pain and so on. Individuals are likely to develop hysterauxesis, dyspareunia and sterility etc. Nowadays,the incidence is trending to rapidly ascend. Thus, there is a significant impact on health, fertility and family life of the female. Therapeutically, there are two main types of treatment that are conservative and radical. Conservative treatment includes High Intensity Focused Ultrasound(HIFU),Transcervical resection of the endometrium (TCRE),Uterine arterial embolization(UAE) and some related drugs and so on. Though radical surgery excludes discomfort of the disease thoroughly, hysterectomy results in mental or physical pain which is contrary to modem medical model that is "bio-psychological society". High intensity focused ultrasound (HIFU) tumor therapeutic system is developed as a new technology of non-invasive treatment. The features of the technology are little injury, fast recovery and safety that are confirmed by so much clinical practice. It has been popularized for the treatment of all kinds of solid tumors and uterine adenomyosis. Nowadays, some doctors use HIFU with PEI in the treatment of uterine adenomyosis with the PEI has been popularized in clinical application. But it had not been reported in any literature if the combination of two methods has better curative than using HIFU alone to treat uterine adenomyosis. Therefore, we make a comparative study on the data of the two therapeutic regimens.Purpose:To investigate HIFU combined with PEI has better clinical therapeutic effect than using HIFU only in treatment of uterine adenomyosis.Methods:1. A retrospective study of patients who diagnosed as adenomyosis in the Second Affiliated Hospital of Chongqing Medical University from August 2011 to January 2015, and divided into two groups after the cases were selected. Group A represented that HIFU was combined with PEI. Group B represented that HIFU was used exclusively. The preoperative general situation, intra-operative situation and postoperative efficacy of patients were analyzed and comparative evaluation was performed.2. The JC Focused Ultrasound Tumor Therapeutic System is developed by Chongqing Haifu (HDFU) Medical Polytron Tech Co. Ltd.3. Date analysis was performed by spss19.0 statistical software.Results:1.The comparison of preoperative general situation:ages, the position of uterus, the position of lesions, preoperative mean volume of uterine and preoperative mean volume of lesions in both groups did not show statistical significance(P>0.05). The average age of group A was 39.00±3.99 (30-45) years old, preoperative mean volume of uterine was166.63 (115.36-281.08) cm3, preoperative mean volume of lesions was41.26 (28.78-117.96)cm3. The average age of group B was 38.00±4.30(27-46) years old, preoperative mean volume of uterine was 139.43(107.44-211.19) cm3, preoperative mean volume of lesions was 38.39(28.04-74.14)cm3. The picture of preoperative MRI showed focal cases and diffuse cases of two groups had not statistical significance (P>0.05). But the signal of MRI T2WI in group A was much higher than that in group B. The difference had statistical significance(P<0.05),the percentage of slightly higher signal magnetic resonance image in group A was 73.91%,and was 20.00%in group B.2.The treatment parameter of two groups were compared that included average power, the time of irradiation, treatment time, therapy dose, treatment intensity and Energy Efficiency Factor(EEF). There was not obvious statistic difference and the P>0.05. the average power was 303.74±36.52 (227-377) W, the time of irradiation was 1205.70±942.76 (170.00-3433.00)S, the treatment time was 120.39±64.52(17.00-256.00) min, the therapy dose was 383.59±337.45(51.00-122.63)kJ, the treatment intensity was 620.20±204.46 (112.10-936.30)s/h and the EEF was 6.53±6.10 (0.50-23.49) J/mm3. Relatively, the average power was 302.80±56.20(178-400)W, the time of irradiation was 830.17±655.38 (146.00-2763.00)S, the treatment time was 97.63±59.37(11.00-256.00)min, the therapy dose was 260.62±239.54(42.83-1098.1)kJ, the treatment intensity was 526.22±235.41(202.10-958.30) s/h and the EEF was 5.39±4.22 (0.71-16.33) J/mm3.The treatment volume and ablation factor of two groups had statistical significance obviously and the P<0.05. The mean treatment volume of group A was 3.83±3.38 (0.45-16.55) cm3, the mean ablation factor was 61.12±24.40(7.63-105.72)%.On the contrary, the mean treatment volume of group B was 2.27±2.02 (0.60-9.40) cm3 and the mean ablation factor was 28.55±19.36(1.15-61.97)%.3. Patients of two groups were all completed the treatment smoothly.4. The results of statistical dates showed that there was no statistical significance of recent complications and the length of hospital stay after operation between the two groups (P>0.05). The recent complications in two groups included bellyache, vaginal fluid, skin swelling, bloated waist and swoller pain of sacrococcygeal. The length of hospital stay after treatment of group A was 1.96±1.49 (1-7) days, the percentage of bellyache was 39.1%, the percentage of vaginal fluid was 52.2%, the percentage of skin swelling was 21.7%, the percentage of bloated waist was 4.3%, and the swoller pain of sacrococcygeal was 8.7%. The hospital stay after treatment of group B was 2.03±0.96 (1-4) days, the percentage of bellyache was 43.3%, the percentage of vaginal fluid was 40.0%, the percentage of skin swelling was 6.7%and the percentage of bloated waist was 13.3%. Among them a patient of group B showed languid unilateral lower limb postoperatively, who improved after a break.Conclusion:The treatment efficiency and ablation factor of HIFU combined with PEI is significantly higher than that of HIFU was used exclusively in treatment of Uterine Adenomyosis. And the former did not reduce the safety. Therefore, HIFU combined with PEI maybe widely use in clinic in the treatment of Uterine Adenomyosis.