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 occurs in women after pregnancy or with a history of endometrial injury. In recent years, with the implementation of birth control measures such as abortion and other clinical operations for endometrial injury, there are two obvious trends in this disease: first, the incidence is increasing, and second, the age of onset is decreasing and becoming more youthful. To date, there is still no ideal treatment for this disease, which seriously affects the physical and mental health of women of reproductive age.  For younger patients, especially those who have not yet had children, hysterectomy is obviously not a very good method, while for older patients, hysterectomy can cure the disease.  However, what follows is not only the loss of fertility, early perimenopausal symptoms and other currently known manifestations, but also the pelvic floor dysfunction, low ovarian function or even premature aging, low sex life due to surgery is also a problem that we and the patient need to face together in the future; focal resection is less used, mainly because it is difficult to completely remove the lesion, the efficacy is unsatisfactory or easy to recur.  Drug treatment is mainly the use of hormonal drugs to perform pseudo-menopause therapy, the recent effect is obvious, but only temporary, after stopping the drug symptoms and signs often quickly relapse; and the use of drug time is too long, drug treatment side effects and complications are also unacceptable to many patients.  In recent years, with the continuous development of interventional techniques, many scholars have tried to treat AD by interfering with the blood supply of uterine arteries and achieved relatively satisfactory treatment results. Domestic data show that the medium and long-term clinical efficiency is over 95%.  The main principle of this treatment method is: to block the blood supply to the endometrial tissues located between the myometrial walls by embolizing the upper branches of the uterine arteries bilaterally with granular embolic agents of suitable size, so that they become ischemic, hypoxic and then liquefied and necrotic, thus losing the pathological biological effect and achieving the purpose of cure. The normal function of the uterus is preserved because the normal myometrial tissue still has normal lateral branch blood supply without necrosis, and its biological role can be preserved.  The method is simply a small incision of about 2-3 mm in the skin at the root of one thigh (femoral artery) and a puncture needle is used to access the femoral artery, after which the operation is completed and takes about 1 hour. Since the procedure is very minimally invasive, you can eat after the procedure, and you can get out of bed and move freely after 24 hours, and the bleeding, if any, can be reduced or stopped in 24 hours.  Interventional treatment does not aggravate the patient’s condition and does not affect the implementation of other treatments; in other words, even if interventional treatment fails, the patient can still choose other treatments such as surgical resection.  Since this treatment method preserves the patient’s uterus and its functions, the surgery is less invasive, and the patient recovers quickly after the surgery, this treatment method is a good choice for such patients compared to the current surgical treatment, which is mainly based on the removal of the uterus, and the drug treatment, which is mainly based on making the patient amenorrhea.