The Surgical Option And Efficacy Analysis Of Conservative Adenomyosis Lesion Resection Based On New Types Of MRI

Objective:Adenomyosis is referred to endometrium glangs and stroma exist in myometrium disffusely or locally.This retrospective analysis is to compare different efficacy of new types of adenomyosis with lesion resection based on MRI.Trying to provide effective references for conservative operative treatment.Methods:Collecting data of 169 adenomyosis patients whose treatment method was lesion resection of uterus from March 2013 to April 2016,and their major pathological diagnosis is adenomyosis after surgery.Combining with magnetic resonance imaging manifestations,we classified them into four types,according to classification of Yohei Kishi.Their menstruation volume,dysmenorrhea,uterine volume,hemoglobin and pregnancy outcome were evaluated comparatively before and after surgery.Results:The median age of 169 women with adenomyosis is 40(20~57)years old.The follow-up investigation timing is 6 months and 12 months after surgery.Before surgery and 12 months after surgery,The uterine volume of type IV was significant greater than that of type I,II,III,p?0.05,respectively.The uterine volume 6 months after surgery was significant smaller than that before surgery in all types,p?0.05.In type I,III,IV,The uterine volume after 6 months was significant smaller than that after 12 months surgery,p?0.05,respectively,and no significant difference between6 mongths and 12 mongths after surgery in type II;Comparing with type I,menstruation volume in type II,III,IV was significant less before surgery,p?0.05.In all types,menstruation volume after surgery were all less than that before surgery,and there were no significant difference between 6 and 12 mongths after surgery in all types;Before surgery,there were no significant statistical difference about HB in all types,and there were no statistical difference in all types after surgery,p?0.05;Before surgery,there were no statistical difference in all types about dysmenorrhea score VAS.The VAS in all types after surgery 6 months reduced obviously,p?0.05,and the VAS in type IV after surgery 6 months was significant smaller than that 12 months after surgery,p?0.05.Comparing VAS before surgery and 12 months after surgery,difference were outstanding in type I,II,III,p?0.05 respectively.There were two women pregnant naturally,and with no assisted reproduction technology.Conclusion:1.Determining the scope of adenomyosis with MRI is benefical to determine the effective clinic treatment;2.Focal resection of adenomyosis can relieve dysmenorrhea and reduce menstruation volume effectivly in type I,II,III;3.For women with Adenomyosis of type I can be considered to reduce lesions with hysteroscope.Laparoscope or transabdominal lesion cutting can be applied to treat adenomyosis in type II.4.Symptomatic recurrence of type IV is higher than others in adenomyosis women with lesion resection.Hysterectomy can be applied to women with adenomyosis type IV who has no fertility requirement.5.Improving anemia before lesion resection,being aware of massive bleeding during operation and treatment of postoperative anemia.