Clinical Efficacy of Radiofrequency Ablation for Adenomyosis
|School||Fourth Military Medical University|
|Course||Medical Imaging and Nuclear Medicine|
|Keywords||Endometriosis Adenomyosis Radiofrequency ablation Minimally invasive treatment Serum ovarian tumor -associated antigen Ultrasound CEUS|
The first part of transabdominal ultrasound-guided radiofrequency treatment the adenomyosis clinical efficacy of the background and purpose of uterine adenomyosis is a common gynecological diseases, occur in women of childbearing age, a more serious impact on the patient's normal life and work, is currently looking for a The non-invasive or minimally invasive treatment method has become a research hotspot. Of this study was to explore the ultrasound-guided transabdominal minimally invasive surgery Radiofrequency ablation (RFA) treatment of adenomyosis feasibility, safety and short-term clinical efficacy. Method from October 2006 to October 2007 in the First Affiliated Hospital of the Fourth Military Medical University, diagnosed 32 cases of adenomyosis patients underwent ultrasound guided transabdominal RFA. Detailed record of the patient's preoperative menstrual history, including the degree of dysmenorrhea, menstrual flow and menstrual days; postoperative of 1,3,6,10-month follow-up, record the patient's degree of dysmenorrhea, menstrual flow to improve the situation and complications. Detection of preoperative and postoperative 1 CA125 3 months Hb. Descriptive analysis of patients with dysmenorrhea degree of efficiency, the amount of treatment and the incidence of various complications; using t test was used to compare the before and after menstruation days, CA125 and Hb changes. The results of 32 cases of adenomyosis were successful transabdominal ultrasound-guided RFA treatment. Postoperative follow-up time point, the 32 patients, 87.5% (9 cases of posterior wall of diffuse therapeutically effective standards, five cases of anterior wall diffuse type and 14 cases of limitations), the other cases of uterine diffuse, patients with anterior wall diffuse type with right ovarian chocolate cysts and two cases of posterior wall diffuse poor postoperative clinical improvement. The patient's degree of dysmenorrhea improved significantly by the amount compared with the preoperative treatment efficiency of 72%, 80%, and after 10 days of the menstrual period decreased compared with the preoperative (P lt; 0.05). The follow-up period, 30 patients (93.7%) patients with a small amount of pale pink vaginal discharge, 28 patients (87.5%) patients with postoperative transient abdominal pain, 5 cases (15.6%) patients with postoperative anesthesia reaction, in 1 case (3.1 %) in patients with low-grade fever, and in all cases no serious complications. In addition, the postoperative one month compared with the preoperative serum CA125 levels decreased significantly (P lt; 0.05); significantly higher (P lt; 0.05) and 3 months after surgery serum Hb level compared with the preoperative and recovery to normal indicators within . Conclusion Ultrasound-guided minimally invasive surgery through the belly RFA treatment of adenomyosis with a simple, short treatment time, quick, you can repeat the treatment several times, fewer complications, and to preserve the integrity of the female genitalia. As a new treatment, radiofrequency surgery in adenomyosis conservative treatment has broad prospects for development, worth an in-depth exploration and research. The purpose of the second part of the radiofrequency treatment of adenomyosis efficacy evaluation method of this study focuses on the value of the early effects of adenomyosis RFA treatment transabdominal ultrasound. Method of October 2006 to October 2007 in our department voluntarily underwent ultrasound guided abdominal RFA treatment of 32 cases of adenomyosis patients, perioperative ultrasound 2D (2DUS), color Doppler (CDFI ) checks, and the use of second-generation ultrasound contrast agent Sono Vue antecubital intravenous uterine CEUS; after 1,3,6,10 months follow-up measurement of uterine volume, and by describing the analysis of perioperative 2DUS, CDFI CEUS changes, using the t test was used to compare the before and after uterine volume changes, P lt; 0.05 difference significantly significance. Results (1) the preoperative 2DUS image 32 patients with enlarged uterus, endometrial line offset; uneven distribution of echo within the lesion tissue compared to normal muscle wall thickening within echogenic, weakened or intensity ranging from, 14 of which Example gland the fibroids 2DUS image can be seen more clearly the extent of disease, the remaining 18 cases of diffuse lesions is not clear. Postoperative follow-up of 10 months, 2DUS images show the 32 patients each month after uterine volume was progressively reduced, compared with the preoperative differences were statistically significant (P lt; 0.01); ablation region echo to varying degrees strong, the border is still clear. (2) preoperative CDFI flow signals in the 18 patients with diffuse lesions myometrium dendritic distribution of the 15 cases, 3 cases of short linear; 14 patients with localized lesions in the surrounding area without obvious cyclic blood flow surrounding internal color flow signals dendritic four cases, the short linear 10 cases. Postoperative CDFI shown the ablation flow signals in the region in all patients completely disappear. (3) CEUS showed preoperative patients with endometriosis lesions can be seen than normal myometrium, coarse or normal vascular development; postoperative CEUS examination showed no contrast agent perfusion in all patients ablation lesions. Conclusion compared with two-dimensional and color Doppler ultrasound image real time CEUS more intuitive reflect adenomyosis radiofrequency solidification range and residual lesions of the minimally invasive treatment of postoperative regional organizations, to assess the early clinical outcome provides a more objective and effective method.