| ObjectiveTo compare the long-term efficacy and adverse reaction of a combination treatment of High intensity focused ultrasound(HIFU)ablation,dienogest(DNG)and Levonorgestrel-releasing intrauterine system(LNG-IUS),with the combination of HIFU,GnRH-a and LNG-IUS for adenomyosis.MethodsOne hundred and twenty-six patients with adenomyosis were enrolled and received HIFU treatment.All cases were then consecutively administered with DNG(group A,N=38)or GnRH-a(group B,N=88)3 months after HIFU treatment until the LNG-IUS was inserted at the end of the third month.All of the cases were followed up to 2 years.Propensity score matching method(PSM)was used to balance the baseline differences between each group.The visual analog scale(VAS),COX dysmenorrhea symptom scores and scores of Pictorial blood loss assessment chart(PBAC)and menstrual volume were measured.Also,the incidences of recurrence and adverse reaction were recorded.ResultsThere were no statistical significant differences among age,BMI,CA12,level,gravidities,cesarean section times,position of uterine as well as menstrual volume,type of lesion,site of main lesion,volume of localized lesion between the two groups before matching,except for parities(p<0.05).After 1:2 PSM matching,114 patients were finally screened out,including 38 patients in group A and 76 in group B.There was no significant difference in baseline level and HIFU parameters between each group after matching.The VAS scores,COX scores and PBAC scores of each group were significantly declined at every follow-up time after HIFU ablation(p<0.05),but VAS score of at 24th month was higher than that of the 18th month in group B.VAS score and the symptom duration score of group A were significantly lower than those of group B 3 months after the ablation(p<0.05),and the severity score of symptoms of the group A was also lower than that of group B at the 1st and 3rd month(p<0.05).The PBAC scores of group A were higher than those of group B at 3rd,18th and 24th month(p<0.05).The reduction rate of menstrual volume of group B was higher than that of group A at 3rd and 24th month[(31.81 ± 0.17)%vs.(25.42 ± 0.10)%,51.00(27.00,62.00)%vs.30.00(17.00,42.75)%](p<0.05).The incidence of excessive uterine bleeding group A(13.16%)was significantly higher than that of group B(2.63%)6 months after HIFU therapy.The incidence of other adverse reactions of group B(46.05%)was significantly higher than that in group A(15.79%).The effective rate of reducing uterine bleeding of group A(92.11%)was lower than that of group B(94.73%).There was no significant difference in the efficacy of dysmenorrea,the overall re-intervention and recurrence rates between each group.Analysis among subgroups based on the type of lesion(including A1-focal,A2-diffuse,B1-focal,B2-diffuse)showed no significant differences in baseline level and the ablation rate among all groups.The PBAC score of group A2 was higher than that of group B2 at the 18th and 24th month(p<0.05).There were no significant differences in both VAS scores and COX scores of pairwise comparisons among subgroups.Multivariate analysis showed that the treatment of group A was prone to cause excessive uterine bleeding.ConclusionsThe combination of HIFU,DNG and LNS-IUS is effective and has few adverse reactions in the treatment of adenomyosis,but prone to cause excessive uterine bleeding,with similar long-term efficacy to that combined with HIFU,GnRH-a and LNS-IUS in relieving dysmenorrhea. |
