Clinical Study On Conservative Surgery And Pathogenesis Associated With Dysmenorrhea Of Adenomyosis

Objective: Adenomyosis?AM? is a common clinical disease in gynecology.The common presenting symptoms of adenomyosis are menorrhagia,dysmenorrhea and infertility,female reproductive health and quality of life are severely affected by dysmenorrhea which incidence is as high as 15%³0%.Therefore,to clarify the mechanism of dysmenorrhea and explore effective treatment are the main purpose of clinical research.Aims of this paper:The first,mild and moderate adenomyosis patients who undergoing conservative treatment is ineffective and severe adenomyosis patients who strongly want to preserve the uterus were as research subjects,conservative surgery which combined adenomyomectomy using the “H”type with Mirena was as research focus,through using a prospective and self controlled clinical observation to evaluate the clinical efficacy and safety of combined adenomyomectomy using the H”type with LNG-IUS for the treatment of adenomyosis.The second,to investigate the relationship between the expressions of NGF and TGF-?1 in the eutopic and ectopic endometrium and dysmenorrhea,the effect of LNG-IUS on the expressions of NGF and TGF-?1 in adenomyosis patients,explore the possible involvement of NGF and TGF-?1 in dysmenorrhea associated with adenomyosis and molecular mechanism of LNG-IUS relieve dysmenorrhea.Methods: 1 Clinical ObservationFrom Feb.2012 to May.2015,fifty-seven women with uterine adenomyosis underwent adenomyomectomy using the “H”type with LNG-IUS in the Second Hospital of Hebei Medical University.Visual analog scale?VAS? score,menstrual flow,uterine volume,serum CA125 level and hemoglobin level of the fifty-seven patients were compared between before and after surgery(the 1^st, 3^rd, 6^th, 12^th, 24^th,and 36^th month),meanwhile to observe postoperative pregnancy,complication and recurrence rate.Postoperative side-effects include surgery-related complications?ischemic necrosis of the uterus,hematoma of uterine incision,infection,fracture,etc.? and the LNG-IUS-related adverse reactions?irregular vaginal bleeding,amenorrhea, breast pain,ovarian cysts,removol,incarceration,ectopia and perforation of LNG-IUS?. 2 Histological ExaminationFrom Feb.2014 to Oct.2015,62 adenomyosis patients undergoing hysterectomy or adenomyomectomy in the Second Hospital of Hebei Medical University were enrolled in this study,who were classified into 33 cases in dysmenorrhea group,16 cases in non—dysmenorrhea group and 13 cases in LNG-IUS-treated group based on visual analogue scale?VAS? and LNG-IUS-treated history.Dysmenorrhea group included 14 cases in mild to moderate pain group and 19 cases in severe pain group.In the mean time,13 patients without adenomyosis and dysmenorrhea were as control group.The expression of NGF and TGF-?1 in the eutopic and ectopic endometrium were examined by immunohistoehemistry.Results: 1 Clinical Observation 1.1 The dysmenorrhea complete remission rate of 53 followed-up patients in the 1^st, 3^rd, 6^th, 12^th, 24^th,and 36^th month was respectively 54.2%?26/48?,72.1%?31/43?,80.0%?40/50?,83.8%?31/37?,87.5%?21/24?and 88.9%?16/18?.VAS score,menstrual flow,uterine volume and serum CA125 level of 53 followed-up patients were significantly reduced after surgery?P?0. 001?,and the differences of VAS score in the 1^st, 3^rd and 6^th month, menstrual flow in the 1^st, 3^rd, 6^th, 12^th and 24^th month, uterine volume in the 1^st, 3^rd, 6^th, 12^th, 24^th,and 36^th month and serum CA125 level in the 1^st and 3^rd month were statistically significant?P?0.05?. 1.2 Of 5 women who wished to conceive,1 became pregnant after IVF-ET, went to preterm and delivered two healthy babies.1 undergoing IVF-ET in the reproductive department after removing LNG-IUS. 1.3 Of all related adverse reactions,the most common side effect was amenorrhea? n=20,37.7%?.There were no cases of LNG-IUS removal,ectopia,expulsion and incarceration,apart from 2 patients due to pregnancy,1 patient due to uterine bleeding and 1 patient due to Mirena perforation from incision of the uterine fundus.All patients had no relapse. 2 Histological Examination 2.1 The expressions of NGF and TGF-?1 level in the eutopic and ectopic endometrium of dysmenorrhea group were higher than painless group and the control group,the differences were statistically significant?P <0.05?. 2.2 The differences of severe pain group,mild to moderate pain group and painless group were statistically significant?P<0.05?.The expressions of NGF and TGF-?1 in the eutopic and ectopic endometrium,both and VAS score had a significant correlation?P<0.001?. 2.3 The expressions of NGF and TGF-?1 in the eutopic and ectopic endometrium of LNG-IUS-treated group were lower than dysmenorrhea group,the differences were statistically significant?P <0.05?.Conclusions: 1 Clinical ObservationAdenomyomectomy using the “H”type with Mirena can be used as a novel and effective conservative surgical treatment of adenomyosis. 2 Histological Examination 2.1 The upregulated expressions of NGF and TGF-?1 in the eutopic and ectopic endometrium associated with adenomyosis were possible involved in producing dysmenorrhea by playing various mechanisms. 2.2 The suppression of NGF and TGF-?1 by LNG-IUS is possible another mechanism of relieving pain in patient with adenomyosis.