High-intensity Focused Ultrasound For Adenomyosis: Clinical Trial Research

Adenomyoma(AM)is characterized by the presence of heterotopic endometrial glands and stroma within the myometrium,with the surrounding muscle layer cells of compensatory hypertrophy and hyperplasia.Patients suffered excessive volume of menses and dysmenorrhea,seriously affecting the patients daily life and work.However,the pathogenesis of AM is unknown,and this subsequently results in difficulty of the management in these patients,especially those who are symptomatic but have a strong desire to preserve their uterus.Studies focusing on the topic of treatment for adenomyosis are the hotspot.With the progress of technology and clinical exploration,More and more conservative treatment method are applied to AM,such as medical therapy,surgical treatment and non-invasive treatment.And till now hysterectomy is the only rational and complete procedure.Due to the increased morbidity and younger trend of AM,hysterectomy is not accepted by patients,non-invasive treatment is a new hotspot choose,such as levonorgestrelreleasing in uterine system(LNG-IUS),uterine arterial embolization,(UAE)and high intensity focused ultrasound(HIFU).However,the aim of noninvasive treatment is to relief of dysmenorrheal and decreased menstrual bleeding,more attentions are payed on the study of the relief of dysmenorrhea and its mechanism.As one of pain related factors,nerve growth factor(NGF)has attracted attention of the scholars.In recent years,many domestic and foreign research pay more attentions on NGF and its receptor nerve growth factor receptor(NGFR).They found that NGF and NGFR had great relationship with the dysmenorrhea caused by AM.With the progress of imaging technology,studies have shown that the uterine junctional zone(JZ)features are mostly associated with AM,which give us a new chance to understand dysmenorrhea and its mechanism,to provide some new treatment method.Objectives:1 To compare of the efficacy of LNG-IUS,UAE and HIFU in the treatment with AM.2 The aim of the present study is to observe the clinical results of treatment of AM by HIFU and to explore HIFU ablation the JZ can relief dysmenorrheal caused by AM effectively,with the expression of NGFR in the uterine junction zone as the background point.3 The aim of the present study is to explore the relationship between NGFR expression intensity and dysmenorrheal by detecting the expression of NGFR in the uterine junction zone,Combing the research status review of the dysmenorrhea mechanism at home and abroad.Methods:1 Clinical research1.1 In this study,60 women with AM were assessed who choosed LNGIUS,UAE or HIFU,respectively.All patients were without history of infection and hormone therapy.Clinical evaluations were carried out at baseline,at 1,6 and 12 month postoperation.The clinical results were enrolled with VAS dysmenorrhea score,menstrual blood volume,uterine volume,lesions volume,postoperative MRI and ultrasound,complications or pregnancies.Analyze the index changes by the method of repeated measurement in group,and the index changes analyzed by ANOVA or Kruskal-Wallis-H in each group.1.2 In this study,33 women with AM were assessed who choosed HIFU,all patients without history of infection and hormone therapy.All patients were treated by the same performer,and ablated the JZ during the treatment.MRI was performed at baseline,Clinical evaluations were carried out at baseline and at 1,6 and 12 month postoperation.The clinical results were enrolled with VAS dysmenorrhea score,menstrual blood volume,uterine volume,postoperative MRI and ultrasound,complications or pregnancies.Analyze the index changes by the method of repeated measurement.In this study,40 women with adenomyosis were assessed who choosed hysterectomy,all patients without history of infection and hormone therapy.Every case had a dysmenorrhea degree from 0 to 10 according to the method of visual analogue scale score(VAS)preoperative respectively.Samples of the JZ were collected from those 40 adenomyosis after hysterectomy.The size of samples was about 15mm�15mm�5mm,selected reference to the preoperative magnetic resonance imaging(MRI).Then formalin-fixed,paraffin-embedded.All samples employed SP immunohistochemical method to detect the expression of NGFR in JZ in AM.Observe the staining intensity and percentage of positive cells each sample in microscope.The positive expression of each sample was the product of staining intensity number by the percentage of positive cells.The relationship between NGFR expression in JZ and dysmenorrheal caused by AM was analyzed by Spearnan's Bivariate Correlation.Results:1 Clinical research1.1 Follow up all the AM patients who were treated by LNG-IUS UAE or HIFU,result showed that: dysmenorrhea score significantly decreased(F= 587.09,P<0.001),the difference was statistically significant in each group(F= 3.53,P<0.05);Menstrual blood volume decreased significantly(F=232.94,P<0.001),the difference was statistically significant in each group(F=4.33,P<0.05);The uterine volume was decreased obviously(F=234.54,P<0.001),the difference was statistically significant in each group(F=3.90 P<0.05);The lesions volume was decreased(F=61.27,P<0.001),the difference was statistically significant in each group(F=3.29,P<0.05);There was no adverse reactions,and 3 patients recrudesced in LNG-IUS,1 patients recrudesced in UAE and one in HIFU.1.2 Follow up all of the AM patients who ablated the JZ by HIFU,Result showed that: dysmenorrhea score significantly decreased(F=246.94,P<0.001);Menstrual blood volume decreased significantly(F=252.00,P<0.001);The uterine volume was decreased obviously(F=107.47,P<0.001);There was no 2 The laboratory research adverse reactions,and 4 cases of the patients pregnancy normally,3 patients recrudesced.2 The laboratory research1.1 NGFR was detected in JZ in all 40 patients with AM,and it mainly expressed in the cytoplasm of glands.1.2 NGFR had great relationship with the dysmenorrhea caused by AM,with the increase of dysmenorrhea score,the expression of NGFR enhanced,the result was statistically significant(r = 0.932,P<0.001).Conclusions:1 The efficacy of LNG-IUS UAE and HIFU program in treatment of AM was similar,they can relief of dysmenorrheal,decreased menstrual bleeding and decreased uterine volume effectively.While the long-term effect of HIFU and UAE was better than LNG-IUS.And HIFU was less invasive,faster recovery and less side effects.2 HIFU could relief dysmenorrheal caused by AM effectively,by ablating the JZ.3 NGFR had great relationship with the dysmenorrhea caused by AM,with the increase of VAS score,the expression of NGFR enhanced.