A clinical analysis of 286 cases of adenomyosis of uterus

Objective To investigate clinical characteristics,diagnosis and treatment of adenomysis of uterus.Methods Clinical data of 286 patients with adenomysis of uterus confirmed by histo-pathology admitted in our hospital over a period from January 2001 to December 2005 were analyzed retrospectively.Results 286 operations for adenomyosis of uterus accounted for 7.3% of total gynecological operations and 25.1% of all hysterectomy in the same period.174(60.8%) patients were operated on for dysmenorrhea and 125patients(43.7%) for menorrhagia and menstrual disorders.182(63.3%)patients were associated with endometriosis,137(47.9%)patients were associated with hysteromyomas and 54 patients(18.9%) were associated with pelvic inflammatory disease.195 cases were diagnosed as adenomysis of uterus preoperatively with 68.2% diagnostic accordance rate.164 patients received total laparoscopic hysterectomy,while 64 patients received classical intrafascial supracervical hysterectomy.42 patients received laparoscopic adenomyosis resection or wedge resection of uterus.16 patients underwent laparoscopic biopsy of the foci.After operation,122 patients received hormone replacement treatment(such as gestyinone,danazol,mifepristone,Marvelon) for more than three months(42.7%) and were followed-up for 1~5 years.The relief rate of dysmenorrhea in women treated with either peritoneal or laparoscopic hysterectomy was 100%,while that in women treated with classical intrafascial supracervical hysterectomy was 95.3%.Dysmenorrhea was relieved in 91.4% of patients treated with conservative operation combined hormonotherapy after one year and dysmenorrhea was relieved in 81.0% of the patients after two years.Hypermenorrhea was relieved in 42.3% of the patients.58 patients desired to preserve her fertility and 22 patients had pregnancy after operation,of which,14 women had term delivery and 7 women had spontaneous abortion and 1 woman had uterine rupture at 6 months of gestation.Conclusion Hysterectomy remains the dominant and radical treatment of adenomyosis of uterus up to now.But for younger patients who desire to preserve her fertility,the age,histopathological type of the lesion and family economic condition all should be comprehensively analyzed to work out an individualized treatment scheme for the patients.