Long-Term Clinical Observation of Various Minimal Invasive Conservative Surgical Procedures for Adenomyosis and Analysis of Factors Influencing Postoperative Reproductive Prognosis

Objective To explore the long-term effects of various minimal invasive conservative surgical procedures on adenomyosis(AM),and to investigate the factors influencing postoperative reproductive prognosis.Methods Clinical data of 93 patients who were diagnosed with AM and had willingness to retain uterus or requirement for fertility from January 2010 to January 2014 were analyzed retrospectively.These patients were treated with uterine artery occlusion(group A,n=32),lesion resection(group B,n=33),or their combination(group C,n=28).Follow-up indicators were compared among the three groups.Seven potential factors influencing postoperative reproductive prognosis were evaluated by univariate analysis and multivariate logistic regression analysis.Results The menstruation amount,dysmenorrhea score and uterine size significantly reduced after treatment in all the three groups(P0.05).These indictors reached their lowest levels at postoperative month 12,and then showed an upward trend.Furthermore,these indictors in group C were significantly different from those in group A and group B since postoperative month 12(P0.05).Univariate analysis showed that the 1-year pregnancy rate was correlated with age,JZ thickness,EM,standard postoperative medication and assisted reproductive technology(P0.05).Multivariate logistic regression analysis showed that the independent risk factors included age≥35years and JZ thickness12mm(OR=2.327 and OR=3.025,respectively;P0.05).However,JZ thickness10mm and standard postoperative medication were the protective factors for 1-year pregnancy rate(OR=0.328 and OR=0.357,respectively;P0.05).Conclusion Both uterine artery occlusion and lesion resection,especially their combination,have longterm curative effects on AM.Multiple factors are correlated with postoperative reproductive prognosis.