The medium to long term clinical outcomes of laparoscopic conservative surgery on adenomyomas

Objective To investigate the clinical characteristics and treatment effects of laparoscopic conservative surgery on adenomyomas. Method A total of 72 patients undergoing laparoscopic resection of adenomyoma in Peking Union Medial College Hospital between April 2004 and July 2007 were studied retrospectively. The data of clinical manifestation, adjuvant therapy,follow-up results and pregnancy outcomes were assessed. The association factors of recurrence and pregnancy were analyzed. Result (1) Two years after surgery,patients had statistically significant relief of dysmenorrhea,shrinkage of uterine volume and decline of serum CA125 level (P 0. 05) . (2) The symptom relapse rate was 34. 7% . Median interval between surgery and relapse was 30 months. The relapsed patients were featured with statistically significantly younger age,larger uterine volume and lower pregnancy rates following surgery (P 0. 05) . (3) Though the surgical followed by GnRHa group had statistically significant larger uterine volume,higher rates of multiple adenomyomas and concurrent endometriosis (P 0. 05) ,the relapse rate was not significantly different from the surgical-only group. (4) The pregnancy and delivery rates were 68. 8% and 46. 9% ,respectively. Median interval between surgery and pregnancy was 13 months. No clinical factors had been proved to have statistically significant influence on pregnancy. Conclusion For the patients with localized adenomyosis who desired to preserve fertility,laparoscopic resection of adenomyoma was effective to relieve the symptom and improve the pregnancy. Younger age and larger uterine volume were risk factors for recurrence. Pregnancy following surgery was a potentially protective factor for recurrence. Surgical followed GnRHa provided more effective symptom control (a lower relapse rate) ,but the benefits for pregnancy were not certain.