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. 2019 Mar;98(11):e14579.
doi: 10.1097/MD.0000000000014579.

Clinical efficacy of adenomyomectomy using "H" type incision combined with Mirena in the treatment of adenomyosis

Yanfei Gao  1 , Shuzhi Shan, Xin Zhao, Jing Jiang, Dongxiao Li, Bin Shi
Affiliations

Clinical efficacy of adenomyomectomy using "H" type incision combined with Mirena in the treatment of adenomyosis

Yanfei Gao et al. Medicine (Baltimore). 2019 Mar.

Abstract

To evaluate the clinical efficacy and safety of adenomyomectomy using "H" type incision combined with Mirena (LNG-IUS) in the treatment of adenomyosis.A total of 57 women with adenomyosis who underwent adenomyomectomy using "H" type incision combined with LNG-IUS were selected. Visual analog scale (VAS), menstrual flow, uterine volume, serum CA125 levels and hemoglobin amounts were compared before and after the surgery. Meanwhile, postoperative pregnancy, adverse reactions, and recurrence were observed.VAS score, menstrual flow, uterine volume, and serum CA125 levels in 53 patients were significantly reduced after surgery (P < . 001). Moreover, statistical significances were obtained for VAS score at 13 and 6 months, menstrual flow at 1, 3, 6, 12, and 24 months, uterine volume at 1, 3, 6, 12, 24, and 36 months and CA125 levels at 1 and 3 months (P < .05). Of the 5 patients with fertility requirements, 1 became pregnant after IVF-ET, progressed to preterm, and delivered healthy twins. Among all related adverse reactions, amenorrhea was the most common (n = 20, 37.7%). There were no cases of LNG-IUS removal, ectopia, expulsion, and incarceration, except in 2 patients due to pregnancy, 1 due to uterine bleeding, and 1 due to Mirena perforation from incision of the uterine fundus. All patients showed no relapse.Adenomyomectomy using "H" type incision combined with Mirena constitutes a novel and effective conservative surgical procedure for adenomyosis treatment.

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Conflict of interest statement

The authors have no conflicts of interest to disclose.

Figures

Figure 1
Figure 1
Surgical sketch[9] and operative methods of adenomyomectomy using “H” type incision.
Figure 2
Figure 2
Complete remission rate of dysmenorrhea after surgery.
Figure 3
Figure 3
(A) Laparoscopy was performed 12 months after surgery; (B) TVS was performed through vagina 12 months after surgery. TVS = transvaginal sonography.
See this image and copyright information in PMC

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