Risk Factors Of Hysterectomy For Uterine Adenomyosis After HIFUa

Objective:To explore the risk factors of hysterectomy after high intensity focused ultrasound ablation for adenomyosis.Method:1.From June 2017 to December 2019,347 patients with uterine adenomyosis were selected from Nanchong Central Hospital and treated with HIFUa.The patients were divided into 2 groups according to whether have a hysterectomy or not.Retrospective analysis of clinical and imaging data for all patients and partial treatment.Univariate and multivariate Cox regression analysis were used to analyze the risk factors of hysterectomy after HIFUa.According to the uterine volume of patients with adenomyosis,the hysterectomy group was matched with the control group by greedy algorithm,and then the risk factors of hysterectomy after HIFUa were analyzed by univariate and multivariate Cox regression analysis.1.Relevant parameters were obtained according to preoperative ultrasound localization and MRI.2.Statistics:SPSS 25.0 was used to analyze the data:Chi-square test is used for counting data and Mann-Whitney U test is used for measuring data;Cox regression analysis was used to analyze the risk factors of hysterectomy;bilateral test was used,P<0.05 was statistically significant.Use SPSS to draw the Kaplan-Meier curve.Use greedy algorithm to paired.Result:1.Univariate analysis showed that there were significant differences in menstrual volume score,dysmenorrhea degree score,uterine volume,lesion volume and immediate nonperfused volume ratio between hysterectomy group and control group(P<0.05).The results of univariate cox regression analysis showed that Hemoglobin value,intensity T2 signal intensity,uterine volume and immediate nonperfused volume ratio were statistically significant factors(P<0.05),and multivariate analyses is suggested that Hemoglobin value,T2 signal intensity,uterine volume and immediate nonperfused volume ratio had influence on hysterectomy of uterine adenomyosis after HIFUa.K-M curve showed that hemoglobin<110g/L,equal or high signal on T2 weighted,uterine volume>213.51cm3 and INPVR<80%had higher risk of hysterectomy than hemoglobin≥110g/L,T2 signal intensity of low signal,uterine volume≤213.51 cm3 and INPVR≥80%.2.(1:2)matched case-control study univariate analysis showed that there were significant differences in menstrual volume score,dysmenorrhea degree score,uterine volume,lesion volume,T2 signal intensity,INPVR and LNG-IUS(P<0.05).The results of univariatecox regression analysis show that Hemoglobin value and T2 signal intensity are statistically significant influence factors(P<0.05),and multivariate cox regression indicates that Hemoglobin value,T2 signal intensityare statistically significant influence indicators.K-M curve showed that hemoglobin<110g/L and equal or high signal on T2 weighted had higher risk of hysterectomy than hemoglobin ≥110g/L,and equal or high signal on T2 weighted.Conclusion:Uterine volume,T2 signal intensity,hemoglobin value and immediate nonperfused volume ratio are independent risk factors for hysterectomy of uterine adenopathy after HIFUa.