Clinical Efficacy and Safety of Major Uterine Wall Resection and Reconstruction of the Uterus Combined with LNG-IUS for the Treatment of Severe Adenomyosis

Abstract

Objective Aim of the study was to evaluate the clinical efficacy and safety of major uterine wall resection and reconstruction of the uterus (MURU) combined with a levonorgestrel-releasing intrauterine system (LNG-IUS) for the treatment of adenomyosis.

Methods Ninety patients diagnosed with adenomyosis were enrolled in this study. All participants were examined by transvaginal ultrasound (TVU) or magnetic resonance imaging (MRI). Serum levels of cancer antigen 125 (CA 125) were quantitatively measured. All patients underwent MURU in combination with LNG-IUS. The therapeutic safety of MURU was assessed during surgery and the patientsʼ stay in hospital. The clinical efficacy was evaluated by comparatively analyzing changes in dysmenorrhea, volume of menstrual blood, uterine volume and serum levels of CA 125 before, and at 3, 6 and 12 months following MURU.

Results All 90 patients enrolled in the study were successfully treated with MURU combined with LNG-IUS. No significant complications were observed during surgery and hospital stay. The mean operation time, intraoperative blood loss and length of hospital stay were 82.4 ± 13.8 min, 53.3 ± 20.3 ml, and 4.3 ± 0.8 days, respectively. Dysmenorrhea completely disappeared in all patients. Uterine volume and serum levels of CA 125 were restored to normal ranges. No recurrence of adenomyosis was observed during postoperative follow-up.

Conclusion MURU combined with LNG-IUS is an efficacious and safe treatment for severe adenomyosis. This combined technique is not only effective to manage severe adenomyosis but also preserves as much of the uterus as possible.

Zusammenfassung

Zielsetzung Ziel dieser Studie war es, die klinische Wirksamkeit und Sicherheit der Uteruswandresektion gefolgt von Uterusrekonstruktion (MURU) in Verbindung mit Levonorgestrel-Intrauterinsystemen (LNG-IUS) bei der Behandlung von Adenomyose zu evaluieren.

Methoden Neunzig mit Adenomyose diagnostizierte Patientinnen wurden in diese Studie aufgenommen. Alle Teilnehmerinnen wurden mit transvaginalem Ultraschall (TVUS) bzw. Magnetresonanztomografie (MRT) untersucht. Die Serumkonzentrationen des Tumormarkers CA-125 wurden gemessen. Alle Patientinnen unterzogen sich einer MURU-Operation in Kombination mit LNG-IUS. Die therapeutische Sicherheit des MURU-Eingriffs wurde während der Operation und dem darauffolgenden Krankenhausaufenthalt bewertet. Die klinische Wirksamkeit wurde evaluiert. Veränderungen bei den Symptomen der Dysmenorrhö, dem Ausmaß an Menstruationsblutung, im Uterusvolumen sowie Serumkonzentrationen von CA-125 vor sowie 3, 6 und 12 Monate nach dem MURU-Eingriff wurden gemessen.

Ergebnisse Alle 90 in der Studie aufgenommenen Patientinnen wurden erfolgreich mit MURU in Kombination mit LNG-IUS behandelt. Es traten keine signifikanten Komplikationen während der Operation und dem Krankenhausaufenthalt auf. Die mittlere Operationsdauer, der mittlere intraoperative Blutverlust und die mittlere Dauer des Krankenhausaufenthalts betrugen jeweils 82,4 ± 13,8 Minuten, 53,3 ± 20,3 ml bzw. 4,3 ± 0,8 Tage. Die Symptome von Dysmenorrhö verschwanden gänzlich bei allen Patientinnen. Gebärmuttervolumen und der CA-125-Spiegel normalisierten sich. Bei keiner Patientin trat Adenomyose in der Nachbeobachtungszeit wieder auf.

Schlussfolgerung MURU in Verbindung mit LNG-IUS ist eine effektive und sichere Methode zur Behandlung schwerer Adenomyose. Diese kombinierte Technik stellt eine effektive Methode zur Behandlung schwerer Adenomyose dar und erhält zudem noch einen Teil der Gebärmutter.

Key words

major uterine wall resection and reconstruction of the uterus - levonorgestrel-releasing intrauterine system - adenomyosis - clinical efficacy - safety

Schlüsselwörter

Uteruswandresektion mit Uterusrekonstruktion - Levonorgestrel-Intrauterinsystem - Adenomyose - klinische Wirksamkeit - Sicherheit

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