High Intensity Focused Ultrasound Ablation For Adenomyosis:A Retrospective Study On The Efficacy And Recurrence Of Dysmenorrhea

Adenomyosis(AM)is a common gynecological benign disease of women of childbearing age.The main clinical manifestations may include dysmenorrhea and progressive aggravation,excessive menstrual flow,prolonged menstrual period,infertility,etc.,which seriously affect the physical and mental health of female patients.Among them,progressively worsened dysmenorrhea is the main symptom of adenomyosis.Total hysterectomy is currently the only way to cure adenomyosis,but this method is unacceptable for patients who want to retain the uterus.Ultrasound ablation,or high intensity focused ultrasound(HIFU),has emerged as an emerging non-invasive thermal ablation technique in recent years.It has absolute advantages in the uterus due to its noninvasive,non-radiative,real-time monitoring,and fast postoperative recovery.The treatment of adenomyosis occupies a place.Related research shows that: HIFU treatment can effectively improve the clinical symptoms of patients with adenomyosis,and the effect is significant.However,previous studies have paid more attention to the short-term efficacy and influencing factors of HIFU in the treatment of adenomyosis,but there have been few studies and reports on the long-term efficacy and recurrence of HIFU after surgery and the related factors affecting the long-term efficacy and recurrence.Objective:1.Assess the therapeutic effect of HIFU on dysmenorrhea in adenomyosis.2.Analysis of recurrence of HIFU for adenomyosis.3.To investigate the related factors of HIFU treatment of adenomyosis affecting the efficacy and recurrence of dysmenorrhea.Methods:A retrospective analysis of 104 clinical cases of adenomyosis patients who were admitted to the First Hospital of Shijiazhuang City and received HIFU for the improvement of dysmenorrhea from January 2013 to January 2018.The patient's dysmenorrhea changes were observed regularly at 3,6,12 months after treatment and every year thereafter.The dysmenorrhea efficacy and recurrence of patients after HIFU treatment were evaluated according to the cases and follow-up data of the follow-up persons,and single factor and multi-factor analysis were used to explore the related factors affecting the dysmenorrhea efficacy and recurrence of HIFU in treatment of adenomyosis.Results:1.92 of 104 patients completed follow-up,the follow-up time was 6-81 months,and the median follow-up time was 31.5 months.The short-term efficacy was evaluated 3 months after treatment: 79 patients were treated effectively,and dysmenorrhea was alleviated to varying degrees,with a total effective rate of 85.9%.The long-term efficacy was evaluated 2 years after treatment: 59 patients were treated effectively and the total effective rate was 64.1%.The follow-up dysmenorrhea rates of 6,12,24,36 months and more than 3 years were 81.5%,72.8%,64.1%,54.5%,and 51.2%,respectively.As of the end of follow-up,54.3% of patients continued to relieve dysmenorrhea.2.Recent evaluation of recurrence of curative effects: 24 of the 79 patients who responded effectively had recurrence of symptoms,with a total recurrence rate of 30.4%.The median time to relapse was 18 months after treatment.Long-term efficacy evaluation of recurrence: 4 out of 59 patients with effective treatment relapsed,with a total recurrence rate of 6.8%.The average time to relapse was 3.5 years after treatment.3.The short-term efficacy is related to the scope of the lesion and whether it is combined with adjuvant therapy within 3 months after treatment(P <0.05),in which the lesion is limited and combined within 3 months after treatment(Gn RH-a,LNG-IUS or Gn RH-a + LNG-IUS)the short-term dysmenorrhea relief rate of adjuvant therapy is higher.4.The long-term effect is related to the scope of the lesion and whether it is combined with adjuvant therapy within 2 years after treatment(P<0.05).The lesion is limited,and it is combined with(Gn RH-a,LNG-IUS or Gn RH-a + LNG-IUS)adjuvant therapy within 2 years after treatment.Long-term effect is better.5.Relapse is related to age.The higher the age,the lower the risk of recurrence.Conclusions:HIFU can effectively relieve the symptoms of dysmenorrhea in patients with adenomyosis,the effect is relatively long-lasting,and the focus is limited,and the combined treatment(Gn RH-a,LNG-IUS or Gn RH-a + LNG-IUS)adjuvant therapy is more effective and lasts longer Longer.The recurrence is negatively correlated with the age of the patient at the time of HIFU treatment.The higher the age at the time of treatment,the lower the risk of recurrence;otherwise,the risk of recurrence will be higher.