An Analysis of 446 Cases About the Diagnosis and Treatment of Uterine Adenomyosis

Objective:To investigated the clinical characteristics of uterine adenomyosis in diagnosis and treatment.Methods:Clinical data of 446 cases with uterine adenomyosis from two hospitals confirmed by pathological examination were analyzed retrospectively.Results:The incidence of adenomyosis was 18.9% among total patients hysterectomy.In 446 cases,404(90.6%) cases were post-pregnancy,368(82.5%)cases were complicated with the history of artificial abortion,65(14.6%)cases were complicated with cesarean section,401(86.1%) cases had menorrhagia or menostaxis,149(33.4%) cases had anaemia,335(75.1%) cases had dysmenorrhea,70(15.7%) cases had painful intercourse and 386(86.6%) patients had hysteranxesis.Preoperatively,273(51.2%) cases were diagnosed clinically.The serum CA-125 was positive in 63.1% of cases measured,and 326(73.1%) cases were diagnosed by intra-vaginal ultrasonography.All patients were treated by operation.Among them,392 cases were treated with hysterectomy by open abdomen procedure,43 cases with laparoscopy procedure,30 cases with operational modality preserving uterus,11 cases treated by vagina route.There were 260 cases complicated with endometriosis.28 cases complicated with adenomyosis and endometriosis had received hormone treatment,e.g.gestrinone,mifepristone,estrogen or progestins for more than three mouths.Dysmenorrhea was relieved in 24 cases during the treatment,but 23 cases recurred at the second to third menstrual cycle after the cessation of hormone treatment.It was useful to menorrhagia.Conclusions:The history of artificial abortion and pregnancy were the risk factors of development of adenomyosis.The complain of menorrhagia or menostaxis were more common than dysmenorrhea in clinical practice.The detail of history,physical examination,combining with intra-vaginal ultrasonography and serum CA-125 measured were better for improving the diagnosis.Hysterectomy remains the dominant treatment of adenomyosis.The choice of operational modality preserving uterus and laparoscope procedure is better for more and more patients.