Clinical application and midterm results of laparoscopic partial resection of symptomatic adenomyosis combined with uterine artery occlusion

Abstract

Study objective: To examine the clinical application of laparoscopic partial resection of symptomatic adenomyosis combined with uterine artery occlusion (UAO).

Design: Retrospective cohort study (Canadian Task Force classification III).

Setting: A district hospital.

Patients: A total of 37 patients with symptomatic adenomyosis who had indication for surgical intervention but needed conservative treatment.

Intervention: Uterine artery occlusion combined with partial resection of adenomyosis via laparoscopy.

Measurements and main results: From July 2003 through October 2005, 37 patients with symptomatic adenomyosis were treated by UAO combined with partial resection of adenomyosis via laparoscopy. All patients were followed up at 1, 6, and 12 months after the operation to estimate the volume of the uterus and changes of symptoms including pelvic pain and abnormal bleeding. Patients also were asked to participate in a clinical interview every year thereafter. No severe complications were noted during the surgical procedure or follow-up. The mean surgical time was 115.7 +/- 27.5 minutes (Mean +/- SD, 61-171 minutes), the mean blood loss was 80.0 +/- 35.2 mL (50-150 mL), and the median highest body temperature after the procedure was 38 degrees C (range 37.4 degrees C-39 degrees C). The postoperative fever morbidity was 10.8% (4/37). Improvement of menorrhagia occurred in all of 37 and 35 of 37 for dysmenorrhea. Hysterectomy was carried out in 2 patients because of persistence of dysmenorrhea. Pictorial blood loss assessment chart was used to measure menstrual blood loss and an 11-point numeric rating scale was used to evaluate the pain intensity during menstruation. The postoperative median scores of menorrhagia were 58, 56, and 59 at 1, 6, and 12 months, respectively, compared with 158 before treatment. Significant improvement occurred (p <.001, p <.001, p <.001), compared with each other, no significant difference existed (1 vs 6 months, p =.720; 6 vs 12 months, p =.992; 1 vs 12 months, p =.709). The postoperative median scores of dysmenorrhea were 7, 5, and 4 at 1, 6, and 12 months. Respectively, compared with 8 before operation; significant symptom lessening occurred (p <.001, p <.001, p <.001). Comparing with each other, significant difference also existed (1 vs 6 months, p <.001; 6 vs 12 months, p <.001; 1 vs 12 months, p =.0018). The volume of the uterus before procedure was 224.6 +/- 48.7 cm(3) (156.0-336.1 cm(3)). At 6 and 12 months it was 169.2 +/- 78.1 cm(3) (118.4-218.2 cm(3)) and 91.6 +/- 28.4 cm(3) (43.1-127.5 cm(3)), respectively. At 6 months after surgery the volume of uterus shrank 24.7% compared with preoperative volume; shrinkage rate was 59.2% at 12 months after surgery. A continuous decrease occurred (p <.001, p <.001, p <.001).

Conclusion: Laparoscopic partial resection of adenomyosis combined with UAO is an effective treatment modality for symptomatic adenomyosis, but further controlled studies with large samples and long-term follow-up is needed for a decisive conclusion.