Clinical Study Of Combined Therapy Of Western Medicine And Traditional Chinese Medicine For Main-Lesion-Removed Adenomyosis

BackgroundAdenomyosis is a disease caused by endometrium invasion into the myometrium of uterus with dysmenorrhea,heavy menstrual bleeding and uterine enlargement as its main manifestations,which seriously affects the physical and mental health and quality of life of the patients.At present,there are almost no effective therapy for it.For the severe patients has to be choosen at last.However,their fertility function could be completely lost.For the cases desiring to save the uterus,drug therapy always meets with recurrence,and adenomyosis lesion removal operation has the shorcomings of incomplete removal of the lesions.Therefore many research showed that the combination of surgical lesion removal and drug therapy coul be more effective.But there was much difference in the completeness of lesion removal and in choice of drug therapy among different ways of treatment.Laparoscopic surgery in gynecology has its advantages such as small wound incision,quick recovery and less post-operative intraperitoneal adhesion formation.Many authors used pneumoperitoneum laparoscopic surgery for the adenomyosis lesion removal.In the pneumoperitoneum laparoscopic operation doctors may meet such problems as difficulty insuturing the wound of uterus.While with gasless laparoscopic operation,surgeons can suture more easily,which can overcome the problems in the pneumoperitoneum laparoscopic operations.We have performed gasless laparoscopic operation for adenomyosis lesion removal for more than 10 years.And during the operation,LEEP techniques can also satisfactarily used in cutting the lesions.Along with gasless laparoscopic lesion removal GnRHa was used to control the growth of residual lesions.Then according to the patients' conditions,levonorgestrel intrauterine release system(LNG-IUS)or Tradional Chinese medicine was used to treat the disease.The combined therapy was clinically found to be effective.ObjectivesGasless laparoscopic adenomyosis lesion removal combined with GnRHa injection were first used to treat adenomyosis.Then LNG-IUS or Chinese medicine Hongteng mixture was respectively used.Objective here is to evaluate the long-term consolidation effect of the two methods.MethodFrom January 2015 to May 2017,60 patients with adenomyosis severe enough for hysterectomy were selected as subjects and prospectively studied,in Zhabei Branch of Shanghai Long March Hospital,Shuguang Hospital of Shanghai Traditional Chinese Medical University and Shanghai 9th People's Hospital of Shanghai Jiaotong University School of Medicine.Enrollment criteria were as follows: age 32-42 years,uterus enlarged more than 10 weeks' pregnancy and heavy menstrual bleeding and /or dysmenorrhea.All subjects were inform consented.Ultrasonography examination was taken to detect and locate the lesionbefore operation.Diagnostic curettage was performed for each case before operation to rule out endometrial malignancy.After diagnostic curettage,3.75 mg of tamifluine(GnRHa)was intramuscularly injected.After 7-14 days of the injection,gasless laparoscopic adenomyosis lesion removal was performed.GnRHa was also injected every 28-30 days(according to the 1st injection before operation)for 6 times.Immediately after the last GnRHa injection all the cases were randomly divided into 2 groups:LNG-IUS Group(n=30)and Hongteng Mixture Group(n=30).LNG-IUS Group was given LNG-IUS insertionin uterus 30 days after last GnRHa injection,and Hongteng Mixture Group was orally given Hongteng Mixture immediately after the last GnRHa injection for 6 months.Then dysmenorrhea VAS scores,uterine size,CA125 level,menstrual bleeding of the two groups was observed and compared before and after treatment.ResultsThe petiants' age,preoperative uterine volume,dysmenorrhea VAS score,CA125 level and menstrual bleeding of the two groups were not significantly different(p> 0.05).VAS levels: the scores of VAS in the two groups were lower than those before operation,and there was no statistical difference between the two groups at menstruation recovery and at 12 month after operation.CA125 level: CA125 level was lower in both groups after operation than that before operation.CA125 level was significantly lower in Hongteng Mixture group 6 months and 12 months after operation than that1 month after operation(P < 0.05).CA125 level in LGN-IUS group 3months,6 months and 12 months after operation was significantly lower than that 1 month,and CA125 level in 12 months after operation was lower than 3 months(P < 0.05).Uterine size: the uterine sizes of the two groups after operation were respectively smaller than that preoperatively.The uterine sizes of Hongteng Mixture group 6,12 months after operation were smaller than that 1month after operation.The uterine sizes of 3,6,12 months after the operation was significantly lower than 1 month after operation in LGN-IUS group.Menstrual bleeding: the menstrual bleeding of the two groups was sinificantly less than that before operation after menstruation recovery,and there was no statistical significance between the two groups after operation.However 6 months after last GnRHa injection the menstruation in Hongteng Mixture Group was regular,without irregular vaginal bleeding,4 cases with light menopausal symptoms,2 cases with gastrointestinal discomfort.In LGN-IUS Group 6 cases suffered from irregular vaginal bleeding.There were 7 cases of menopausal symptoms and no intrauterine contraceptive ring abscission.ConclusionGasless laparoscopic surgery combined with LEEP can be more satisfactory in the removal of adenomyosis lesions,and combined with GnRHa treatment can significantly reduce uterine size,significantly improve clinical symptoms and save the uterus.The following treatment of intrauterine LNG-IUS insertion or taking Hongteng mixture can further consolidate the treatment effects.There was no significant difference ineffects of treatment between LNG-IUS insertion and taking Hongteng mixture.But irregular vaginal bleeding occurred in some LNG-IUS patients,and did not occur in patients taking Hongteng mixture.Traditional chinese medicine-Hongteng mixture was effective in the treatment of the patients who underwent lesion-removed operation and GnRHa injection,and needs further studying.