Adenomyosis occurs mostly in menstruating mothers aged 30 to 50 years old. The damage to the endometrial basal layer caused by multiple pregnancies and deliveries, abortions, etc. is closely related to the development of adenomyosis. There is no curative medicine available, but hysteroscopy can be used for both diagnostic and therapeutic purposes by direct visualization of the lesions in the uterine cavity, endomyomectomy and pathology.
The main manifestations of adenomyosis are progressive dysmenorrhea, increased menstrual flow, prolonged periods and infertility. Ultrasound examination is usually performed based on the patient’s complaints. If the uterus is suspected to be diseased, magnetic resonance imaging (MRI) can be performed to further confirm the diagnosis, and pathological histology is the gold standard.
Early adenomyosis can be detected by hysteroscopy just after menstruation, with hysteroscopy revealing.
1. enlargement of the uterine cavity.
2. abnormal glandular openings.
3, blue nevus.
4. trumpet-like structures on the cut surface. It has a specificity of 100% and a sensitivity of 63.6%.
The operation requires sampling and sending to pathology to obtain pathological histological confirmation of the diagnosis. Hysteroscopic diagnosis of adenomyosis is simple, low cost, does not require anesthesia and hospitalization, and has a high degree of patient cooperation.
Indications for hysteroscopic treatment of adenomyosis: 4 types!
1. Diffuse adenomyosis: hysteroscopic endomyomectomy can relieve the patient’s symptoms of dysmenorrhea and increased menstrual flow.
2. Adenomyoma: When performing hysteroscopic treatment of adenomyoma, it is necessary to focus on excision of the part of adenomyoma protruding into the uterine cavity, and to stop cutting until the four walls are equally thick under ultrasound detection to avoid perforation of the uterus due to excessive excision.
3. Adenomyosis: One type is that the smooth muscle of the uterus wraps around the lesion and causes a fibroid to grow on top of the adenomyosis. There is another type of adenomyosis in which the uterine fibroids protrude into the uterine cavity and the endometrium that covers the surface of the uterus invades the fibroids, forming a mass that grows on top of the fibroids. Both types also need to be removed if they are symptomatic. Because of the protrusion into the uterine cavity, it is easier to operate and remove completely in this case, and follow-up observation is usually performed after removal.
4. Cystic adenomyosis: This is a rare condition in which the patient has obvious symptoms of dysmenorrhea and drug treatment is ineffective, and hysterectomy is usually performed. In young women who have not had children, if the cyst wall protrudes into the uterine cavity and does not penetrate the entire myometrium, hysteroscopic excision of the cyst wall protruding into the uterine cavity, excision or electrocoagulation of the displaced endometrial tissue lining the cyst wall, and sampling for pathological histological examination can be performed.
Complications.
1, Uterine perforation.
2, TURP syndrome: generally applied plasma bipolar electrodes system, a large amount of perfusion fluid (saline) absorbed into the circulation, resulting in excessive blood volume, if the monopolar electrodes system is used, excessive absorption of tubular tumor fluid without electrolytes can lead to a series of systemic symptoms caused by hyponatremia, which can cause death in severe cases.
3, bleeding: general application of hemostatic agents, contractions effective, individual need to use water injection balloon to stop bleeding. The application of preoperative gonadotropin-releasing hormone agonist (GnRH-a) can help reduce bleeding in the book.
4, air embolism: it is currently believed that the gas during air embolism can originate from the inlet tube and the air bubbles generated by tissue vaporization.
5.Infection: Symptoms of uterine or pelvic infection include fever, pain, vaginal drainage, persistent uterine bleeding, and uterine tenderness, which are relieved by the use of antibiotics.
6.Uterine adhesions: adhesions are easily formed at the bottom and both sides of the uterus wall after surgery.
7.Blood accumulation in the uterine cavity.
8, abdominal pain.
Hysteroscopy for cystic adenomyosis: collaboration!
Cystic adenomyosis is a cystic structure in the uterus, surrounded by the myometrium and lined with ectopic endometrial tissue. This area is very small, usually no more than 5 mm, and larger cystic lesions are rare. Hysteroscopy has three features: bulging of the cyst into the uterine cavity; endometrial abnormalities at the site of the cyst; and endometrial changes that reduce intrauterine pressure.
Hysteroscopic treatment requires accurate localization under ultrasound supervision, opening of the cyst wall, elimination of accumulated blood, and complete removal of the cyst wall. Large cysts are often difficult to remove cleanly in a limited 1-hour period and require postoperative medications for adjuvant therapy.
The methods of treating cystic adenomyosis are.
1, hysteroscopic radiofrequency needle puncture ablation.
2, hysteroscopic cold instrumentation dissection.
3, hysteroscopic mono- and bipolar electrodesection.
In recent years, hysteroscopic myometrial wall biopsy and hysteroscopic-ultrasound-guided puncture biopsy have been rapidly developed.
Indications for hysteroscopic treatment of cystic adenomyosis.
Located in the inner 1/3 of the myometrial wall; the cystic cavity is seen on ultrasound close to the uterine cavity; the lesion does not penetrate the entire uterine wall; malignant uterine lesions are excluded.