Abstract
Since 2002, we have performed adenomyomectomy for 1780 women with uterine adenomyosis. We classified adenomyosis in these patients as focal (n=1313), diffuse (n=450) or cystic (n=17) type according to the distribution of the focuses seen in magnetic resonance imaging (MRI) findings. Three different surgical methods for focal, diffuse and cystic adenomyosis are utilized at our institution. The adenomyosis lesion is excised using a loop electrode of a high-frequency cutter in all methods. The median resected lesion weight of focal, diffuse and cystic adenomyosis were 94 g (1-1156 g), 150 g (10-1595 g), and 16 g (3-45 g), respectively. The mean visual analogue score for dysmenorrhea decreased from 9.1 to 1.0 and heavy menstrual bleeding was improved in all cases. Following the procedure, 370 pregnancies occurred in 294 patients, of which 153 (41.9%) were the result of natural conception. Pregnancy rate of the patients younger than 40 years were 35.1% in focal type, 25.4% in diffuse type and 88.9% in cystic type. Among those patients, we experienced 5 cases of uterine rupture. Of 1462 patients who underwent surgery more than 2 years prior to the time of writing, recurrence occurred in 150 (10.3%). Our findings indicate that conservative surgery for uterine adenomyosis using a high-frequency resection device is effective for both focal and diffuse type.
Highlights
Conservative management for uterine disease has become an important issue in Japan, because the numbers of women who marry or achieve pregnancy at a later age have been increasing
Dysmenorrhea and menorrhagia were evaluated at 3 months after surgery, with magnetic resonance imaging (MRI) performed for all patients and pregnancy permitted
Based on a definition of recurrence that includes a continuous elevation of serum CA125, reappearance of dysmenorrhea, and detection of adenomyosis lesions in MRI findings, 150 of 1462 patients were diagnosed with recurrence more than 2 years after surgery
Summary
Conservative management for uterine disease has become an important issue in Japan, because the numbers of women who marry or achieve pregnancy at a later age have been increasing. The purpose of an adenomyomectomy procedure is to improve the quality of life for the women who wish to preserve their reproductive capability. Good reviews of the procedure have been presented [1], those reports included only a small number of subjects [2,3,4,5,6,7,8,9,10,11,12,13,14,15,16,17,18,19,20,21,22,23,24,25,26,27,28], with none examining more than 1000 patients. We present details of 1780 patients who have received an adenomyomectomy at our hospital since 2002
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