Interventional treatment of adenomyosis

Adenomyosis, also known as intrinsic endometriosis, is caused by the invasion of endometrial tissue from the basal layer of the endometrium into the myometrium, and is most common in women who are post-pregnant or have a history of endometrial injury. The incidence of endometriosis is reported to be 5% to 70% in foreign countries and 13.4% in China. In recent years, with the implementation of birth control measures such as abortion and the increase of other kinds of endometrial injuries in clinical operations, this disease has two obvious trends, one is the incidence rate is rising, and the other is the age of onset of the decline, and more youthful. Until now, there is still no ideal treatment for this disease, which is called “chronic cancer” and seriously affects the physical and mental health of women of childbearing age. The traditional treatment methods are mainly surgical treatment and drug treatment, and the surgical treatment is nothing but total hysterectomy and lesion excision. For young patients, especially those who have not yet given birth, hysterectomy is obviously not a very good method, and for those who are older, although the hysterectomy can cure AD, the ensuing problems are not only the loss of fertility, the advancement of the perimenopausal symptoms, and other known symptoms, but also the pelvic floor damage caused by the surgery, such as the loss of fertility and the early development of perimenopausal symptoms. performance, the pelvic floor dysfunction, low ovarian function or even premature aging, and low sex life caused by the surgery are also problems that we and the patients need to face together in the future; AD foci resection is less frequently used, mainly because it is difficult to completely remove the foci, and the therapeutic effect is unsatisfactory or prone to recurrence. Drug treatment is mainly the use of hormone drugs for pseudo-menopausal therapy, the recent efficacy is obvious, but only temporary, after stopping the drug symptoms and signs often recur very quickly; and too long a period of time, the side effects of drug treatment and complications are also unacceptable to many patients. In recent years, with the continuous development of interventional diagnostic technology, many scholars have attempted to treat AD by blocking the blood supply of uterine arteries through interventional methods, and have achieved relatively satisfactory therapeutic effects. Domestic data show that the mid- and long-term clinical effectiveness rate reaches more than 85%. The main principle of this treatment method is to use the appropriate size of granular embolic agent to embolize the upstream branches of bilateral uterine arteries, blocking the blood supply to the endometrial tissues that are located in the myometrial wall, so as to make them ischemic, hypoxic and then liquefied and necrotic, thus losing the pathological biological effect and achieving the purpose of cure. Since the normal uterine muscle tissue still has normal collateral blood supply without necrosis, it can retain its biological role, so the normal function of the uterus is preserved. The method is simply to make a small incision the size of a sesame seed (about 2mm) in the skin at the root of the thigh (femoral artery) on one side and use a puncture needle to enter the femoral artery, and then the operation can be completed, the operation time is about 1 hour. Since the procedure is very minimally invasive, the patient can eat after the procedure and can get out of bed and move freely after 20 hours. The intervention does not aggravate the patient’s condition and does not affect the implementation of other treatments; in other words, even if the intervention fails, the patient can still choose other treatments such as surgical resection. Since this treatment preserves the uterus and its function, the surgery is less traumatic and the patient recovers faster after the surgery, this treatment is undoubtedly an excellent treatment for the majority of patients of childbearing age compared with the current surgical treatment which mainly focuses on removing the uterus, and the medication which mainly focuses on making the patient amenorrheic.