Adenomyosis is a benign lesion caused by the invasion of the endometrial base into the myometrium and occurs mostly in menstruating women over 40 years of age. The incidence of adenomyosis has increased in recent years, and the rate of the disease has also increased in infertility clinics. There is still no ideal treatment for this disease, and it is called a “chronic cancer”.
Traditional treatment is based on surgery, supplemented by drugs. Surgical removal of the uterus is not easily accepted by some patients, especially those who are young or have fertility requirements, and drug treatment is not effective, has many side effects and is prone to recurrence. With the continuous development of the application of interventional radiology in obstetrics and gynecology, vascular interventional treatment of adenomyosis has become the latest treatment method, and has achieved good results.
Clinical symptoms.
Gradually increasing dysmenorrhea is its typical symptom, often accompanied by excessive menstruation, menstrual disorders, anemia, which can lead to infertility and, in severe cases, painful intercourse. The uterus is enlarged and hardened on gynecological examination, and the clinical types are classified as slow and focal. The focal type is also known as adenomyoma of the uterus.
Treatment.
Adenomyosis of the uterus is more difficult to treat and the following methods are commonly used.
1, drug treatment: poor efficacy, recurrence after discontinuation of drugs;
2, surgical removal of the uterus: traumatic, loss of fertility;
3, interventional therapy: the efficiency is about 80%, can preserve organs, preserve fertility, minimal trauma, can repeat treatment.
Interventional treatment of adenomyosis
I. Treatment mechanism
The basic function of vascular intervention is to embolize the blood vessels and block the blood flow to the lesion. This is the basic principle and starting point of interventional treatment for adenomyosis, which is to cause necrosis, absorption and atrophy of the lesions in the uterus through embolization of the blood supply arteries of the uterus.
II. Indications and contraindications
(A) Indications
1.Patients with typical clinical symptoms and signs and clear clinical diagnosis such as ultrasound and MRI;
2.Women of all ages, patients with many surgical concerns or those with fertility requirements who do not want to remove the uterus;
3.Patients with a history of pelvic surgery or pelvic adhesions, estimated to be difficult to operate;
4.Patients suffering from heart and lung diseases, hyperthyroidism, diabetes, mental illness and other diseases that are not suitable for open surgery, and those with serious clinical symptoms such as dysmenorrhea and excessive menstruation, which affect their health;
5.Patients who cannot continue drug treatment because of ineffective drug treatment or large side effects;
6. Combined with uterine fibroids.
(B) Contraindications
1.Acute inflammatory period or body temperature above 37.5℃;
2.History of allergy to various contrast agents;
3.Severe cardiopulmonary, hepatic and renal diseases, hyperthyroidism, diabetes mellitus. Patients with uncontrolled disease, unstable vital signs and unable to move;
4.Patients who are pregnant or suspected to be pregnant;
5, pelvic inflammatory disease or vaginitis is not cured;
6.Cancerous cells or suspected cancerous cells found by pathological examination of endometrial scraping, atypical hyperplasia of endometrium;
7, rapid growth of the uterus within a short period of time, suspicious of uterine sarcoma;
8.Severe coagulation dysfunction.
III. Treatment effect
Within 3 months after the interventional treatment, about 80%-90% of the patients’ dysmenorrhea symptoms are obviously reduced and their menstruation returns to normal, and the lesions and uterus are obviously reduced and softened within 3-5 months. Our hospital has applied this technology to the treatment of adenomyosis for 5 years, and more than 50 patients have received interventional treatment, with an efficiency of 80%, and the chance of conceiving after interventional treatment for infertile patients with adenomyosis is greatly increased.