Journal of Shandong University (Health Sciences) ›› 2022, Vol. 60 ›› Issue (7): 26-31.doi: 10.6040/j.issn.1671-7554.0.2021.1551

Previous Articles     Next Articles

Surgical treatment strategies of adenomyosis

ZHANG Xinmei, XU Ping   

  1. Department of General Gynecology, Womens Hospital, School of Medicine, Zhejiang University, Hangzhou 310006, Zhejiang, China
  • Published:2022-07-27

RichHTML

2

PDF (PC)

130

Abstract: Adenomyosis is a common hormone-dependent and inflammatory disease in women of childbearing age, manifested with progressive dysmenorrhea, menorrhagia, infertility and uterine enlargement. The morbidity increases year by year and shows a younger trend. Surgical treatment of adenomyosis is often performed due to ineffectiveness or unwillingness of drug therapy and non-surgical techniques(including uterine artery embolization, high-intensity focused ultrasound therapy and radiofrequency ablation). Specific surgical strategy needs to be formulated individually according to the patients’ age, clinical symptoms, fertility requirements and the type and scope of lesions. At present, surgical procedures include hysterectomy, conservative adenomyomectomy/cytoreductive surgery, hysteroscopic transcervical resection of endometrium/endometrial ablation, and so on. This article reviews the applicable population, key points of operation and maintenance treatment scheme of various surgical procedures, in order to ensure individualized treatment and life-long management of the disease, maximize the curative effects and improve fertility.

Key words: Adenomyosis, Hysterectomy, Adenomyomectomy, Cytoreductive surgery, Hysteroscopy

CLC Number: 

  • R711.74
[1] 中国医师协会妇产科医师分会子宫内膜异位症专业委员会. 子宫腺肌病诊治中国专家共识[J]. 中华妇产科杂志, 2020, 55(6): 376-382.
[2] 黄秀峰, 张信美. 子宫腺肌病的手术治疗现状与思考[J]. 中国计划生育和妇产科, 2019, 11(4): 15-17. HUANG Xiufeng, ZHANG Xinmei. Current status and thinking of surgical treatment of adenomyosis [J]. Chinese Journal of Family Planning & Gynecotokology, 2019, 11(4): 15-17.
[3] 张信美, 徐萍. 子宫腺肌病分层治疗及管理[J]. 浙江大学学报(医学版), 2019, 48(2): 123-129. ZHANG Xinmei, XU Ping. Stratified treatment and management of adenomyosis [J]. Journal of Zhejiang University(Medical Sciences), 2019, 48(2): 123-129.
[4] van den Bosch T, de Bruijn AM, de Leeuw RA, et al. Sonographic classification and reporting system for diagnosing adenomyosis [J]. Ultrasound Obstet Gynecol, 2019, 53(5): 576-582.
[5] Kishi Y, Suginami H, Kuramori R, et al. Four subtypes of adenomyosis assessed by magnetic resonance imaging and their specification [J]. Am J Obstet Gynecol, 2012, 207(2): 114.
[6] Bourdon M, Oliveira J, Marcellin L, et al. Adenomyosis of the inner and outer myometrium are associated with different clinical profiles [J]. Hum Reprod, 2020, 36(2): 349-357.
[7] Kishi Y, Yabuta M, Taniguchi F. Who will benefit from uterus-sparing surgery in adenomyosis-associated subfertility? [J]. Fertil Steril, 2014, 102(3): 802-807.
[8] Tan J, Moriarty S, Taskin O, et al. Reproductive outcomes after fertility sparing surgery for focal and diffuse adenomyosis: a systematic review [J]. J Minim Invasive Gynecol, 2018, 25(4): 608-621.
[9] Osada H, Silber S, Kakinuma T, et al. Surgical procedure to conserve the uterus for future pregnancy in patients suffering from massive adenomyosis [J]. Reprod Biomed Online, 2011, 22(1): 94-99.
[10] 黄琼施, 黄秀峰, 张晶, 等. 改良双瓣法病灶切除术在弥漫性子宫腺肌病中的应用分析[J].实用妇产科杂志, 2014, 30(8): 605-608. HUANG Qiongshi,HUANG Xiufeng,ZHANG Jing, et al. Evaluation on the efficacy of a double-flap method of adenomyomectomy for diffuse uterine adenomyosis [J]. Journal of Practical Obstetrics and Gynecology, 2014, 30(8): 605-608.
[11] Yasuo O, Masato N, Yuko A, et al. Association of uterine wall thickness with pregnancy outcome following uterine-sparing surgery for diffuse uterine adenomyosis [J]. Aust N Z J Obstet Gynaecol, 2016, 56(1): 88-91.
[12] Osada H. Uterine adenomyosis and adenomyoma: the surgical approach [J]. Fertil Steril, 2018, 109(3): 406-417.
[13] Younes G, Tulandi T. Conservative surgery for adenomyosis and results: a systematic review [J]. J Minim Invasive Gynecol, 2018, 25(2): 265-276.
[14] Rocha TP, Andres MP, Borrelli GM, et al. Fertility-sparing treatment of adenomyosis in patients with infertility: a systematic review of current options [J]. Reprod Sci, 2018, 25(4): 480-486.
[15] Gordts S, Campo R, Brosens I. Hysteroscopic diagnosis and excision of myometrial cystic adenomyosis [J]. Gynecol Surg, 2014, 11(4): 273-278.
[16] Philip CA, Le Mitouard M, Maillet L, et al. Evaluation of NovaSure global endometrial ablation in symptomatic adenomyosis: a longitudinal study with a 36- month follow-up [J]. Euro J Obstet Gynecol Reprod Biol, 2018, 227: 46-51. doi: 10.1016/j.ejogrb.2018.04.001.
[17] El-Nashar SA, Hopkins MR, Creedon DJ, et al. Prediction of treatment outcomes after global endometrial ablation [J]. Obstet Gynecol, 2009, 113(1): 97-106.
[18] Ofer G, Jenya K, Michael H, et al. Perioperative predictors of successful hysteroscopic endometrial ablation [J]. Gynecol Obstet Invest, 2007, 63(4): 205-208.
[19] Saremi A, Bahrami H, Salehian P, et al. Treatment of adenomyomectomy in women with severe uterine adenomyosis using a novel technique [J]. Reprod Biomed Online, 2014, 28(6): 753-760.
[20] Nishida M, Takano K, Arai Y, et al. Conservative surgical management for diffuse uterine adenomyosis [J]. Fertil Steril, 2010, 94(2): 715-719.
[21] Shu SR, Luo X, Wang ZX, et al. Fifteen cases clinical analysis of wedge-shaped resection of uterus treating adenomyosis- CONSORT [J]. Medicine(Baltimore), 2016, 95(24): 3805.
[22] Fujishita A, Masuzaki H, Khan KN, et al. Modified reduction surgery for adenomyosis. A preliminary report of the transverse H incision technique [J]. Gynecol Obstet Invest, 2004, 57(3): 132-138.
[23] Sun C, Ren XY, Gao Y, et al. Clinical efficacy and safety of major uterine wall resection and reconstruction of the uterus combined with LNG-IUS for the treatment of severe adenomyosis [J]. Geburtshilfe Frauenheilkd, 2020, 80(3): 300-306.
[24] Gao YF, Shan SZ, Zhao X, et al. Clinical efficacy of adenomyomectomy using “H” type incision combined with Mirena in the treatment of adenomyosis [J]. Medicine(Baltimore), 2019, 98(11): 14579.
[25] 张信美, 石一复. 子宫腺肌症患者子宫次全切除术后的危险性探讨[J]. 现代妇产科进展, 2001, 10(2): 120-122. ZHANG Xinmei, SHI Yifu. The risk in the patients with adenomyosis after supracervical hysterectomy [J]. Progress in Obstetrics and Gynecology, 2001, 10(2): 120-122.
[26] Liu JX, Li JY, Zhao XY, et al. Transvaginal ultrasound- and laparoscopy-guided percutaneous microwave ablation for adenomyosis: preliminary results [J]. Int J Hyperthermia, 2019, 36(1): 1232-1237.
[1] Guoyun WANG,Zangyu PAN. Research progress of animal models of adenomyosis [J]. Journal of Shandong University (Health Sciences), 2022, 60(7): 48-55.
[2] Lei YAN,Zijiang CHEN. Treatment of adenomyosis complicated with infertility [J]. Journal of Shandong University (Health Sciences), 2022, 60(7): 43-47.
[3] Guowei TAO,Fang WANG,Xiangyi DONG,Yaxuan XU,Linli ZHAO,Beibei HU. Diagnosis of adenomyosis using ultrasound and magnetic resonance imaging [J]. Journal of Shandong University (Health Sciences), 2022, 60(7): 56-65.
[4] AILI Aixingzi,Zhengyu GUO,Xiaofei ZHANG. Latest research advances of high intensity focused ultrasound treatment for adenomyosis [J]. Journal of Shandong University (Health Sciences), 2022, 60(7): 36-42.
[5] Xiaofang YI,Jihua HUANG. Patient education and proper management of adenomyosis [J]. Journal of Shandong University (Health Sciences), 2022, 60(7): 32-35.
[6] LENG Jinhua, SHI Jinghua. Clinical manifestations of adenomyosis [J]. Journal of Shandong University (Health Sciences), 2022, 60(7): 1-5.
[7] PENG Chao, ZHOU Yingfang. Progress on the medical treatment of adenomyosis [J]. Journal of Shandong University (Health Sciences), 2022, 60(7): 20-25.
[8] GUO Sunwei, LIU Xishi. Cracking the enigma of pathogenesis and pathophysiology of adenomyosis [J]. Journal of Shandong University (Health Sciences), 2022, 60(7): 6-19.
[9] XU Ge, LI Qing, ZHANG Cancan, TIAN Yongjie. Expressions and clinical significance of PARP-1 and HIF-1α in adenomyosis tissues and primary cells [J]. Journal of Shandong University (Health Sciences), 2022, 60(4): 55-61.
[10] WANG Lu, ZHAO Xinrui, ZHU Lin. Clinical efficacy of laparoscopic radical hysterectomy without lift and tumor spillage in 25 cases of early-stage cervical cancer [J]. Journal of Shandong University (Health Sciences), 2021, 59(6): 76-80.
[11] GENG Chen, YANG Yang, ZHAO Yue, LIU Haoran, CHAO Lan. Identification of differentially expressed genes and Wilms tumor-1 expression in adenomyosis [J]. Journal of Shandong University (Health Sciences), 2021, 59(4): 79-86.
[12] HUO Suxia, LIU Wei, WANG Xin. Experience in the treatment of 86 cases of type Ⅲ cesarean scar pregnancy [J]. Journal of Shandong University (Health Sciences), 2021, 59(1): 40-44.
[13] WANG Bingyu, YANG Yang, CHAO Lan. Expression and role of toll-like receptor 4 in adenomyosis [J]. Journal of Shandong University (Health Sciences), 2020, 58(6): 47-52.
[14] LIU Ya, WANG Yafen, ZHU Lin, ZHANG Ping, MA Demei. Risk factors of malignant transformation trend of 53 cases of endometrial polyps [J]. Journal of Shandong University (Health Sciences), 2020, 58(1): 39-42.
[15] HUANG Yufei, YANG Yang, SHAO Qianqian, DENG Xiaohui, CHAO Lan. Expression and role of adenosine monophosphate dependent protein kinase in adenomyosis [J]. Journal of Shandong University (Health Sciences), 2019, 57(2): 93-98.
Viewed
Full text


Abstract

Cited
  Shared   
  Discussed   
[1] MA Qingyuan, PU Peidong, HAN Fei, WANG Chao, ZHU Zhoujun, WANG Weishan, SHI Chenhui. Effect of miR-27b-3p regulating SMAD1 on osteosarcoma cell proliferation, migration and invasion[J]. Journal of Shandong University (Health Sciences), 2020, 1(7): 32 -37 .
[2] ZHANG Baowen, LEI Xiangli, LI Jinna, LUO Xiangjun, ZOU Rong. miR-21-5p targeted TIMP3 to inhibit proliferation and extracellular matrix accumulation of mesangial cells in Type II diabetic nephropathy mice[J]. Journal of Shandong University (Health Sciences), 2020, 1(7): 7 -14 .
[3] FU Jieqi, ZHANG Man, ZHANG Xiaolu, LI Hui, CHEN Hong. Molecular mechanism of Toll-like receptor 4 in the aggravation of blood lipid accumulation by inhibiting the peroxisome proliferator-activate receptor γ[J]. Journal of Shandong University (Health Sciences), 2020, 1(7): 24 -31 .
[4] DING Xiangyun, YU Qingmei, ZHANG Wenfang, ZHUANG Yuan, HAO Jing. Correlation of the expression of insulin-like growth factor II in granulosa cells and ovulation induction outcomes of 84 patients with polycystic ovary syndrome[J]. Journal of Shandong University (Health Sciences), 2020, 1(7): 60 -66 .
[5] XIAO Juan, XIAO Qiang, CONG Wei, LI Ting, DING Shouluan, ZHANG Yuan, SHAO Chunchun, WU Mei, LIU Jianing, JIA Hongying. Comparison of diagnostic efficacy of two kinds of thyroid imagine reporting and data systems[J]. Journal of Shandong University (Health Sciences), 2020, 1(7): 53 -59 .
[6] GUO Zhihua, ZHAO Daqing, XING Yuan, WANG Wei, LIANG Leping, YANG Jing, ZHAO Qianqian. Single-stage end-to-end anastomosis in the management of severe cervical tracheal stenosis[J]. Journal of Shandong University (Health Sciences), 2020, 1(7): 72 -76 .
[7] XU Jixi, CHEN Weijian. Diffuse midline glioma with H3 K27M mutation in the spinal cord: a case report[J]. Journal of Shandong University (Health Sciences), 2020, 1(7): 96 -101 .
[8] LUO Xin, HE Bing, NIE Qingsheng, HOU Zhenbo, DONG Jun, LI Yuhua, ZENG Xiangqin, LIU Wei, KONG Demin, CAO Jinfeng. Comparison of the value of mono-exponential mode and diffusion kurtosis imaging mode in grading clear cell renal cell carcinoma using magnetic resonance diffusion-weighted imaging[J]. Journal of Shandong University (Health Sciences), 2020, 1(7): 89 -95 .
[9] LONG Tingting, XIE Ming, ZHOU Lu, ZHU Junde. Effect of Noggin protein on learning and memory abilities and the dentate gyrus structure after cerebral ischemia reperfusion injury in mice[J]. Journal of Shandong University (Health Sciences), 2020, 1(7): 15 -23 .
[10] LI Ning, LI Juan, XIE Yan, LI Peilong, WANG Yunshan, DU Lutao, WANG Chuanxin. Expression of LncRNA AL109955.1 in 80 cases of colorectal cancer and its effect on cell proliferation, migration and invasion[J]. Journal of Shandong University (Health Sciences), 2020, 1(7): 38 -46 .
Copyright 2018 © Editorial office of Journal of Shandong University (Health Sciences)
Supported by Beijing Magtech Co.Ltd