Effect of comprehensive management for large diffuse adenomyosis by conservative surgery combined With GnRH-a and LNG-IUS

XU Linna; ZHANG Shaofen; DING Jingxin; GUO Yanrong; LIU Xiaoxia; ZHANG Xuyin

doi:10.19538/j.fk2017060116

Abstract：Objective To investigate the effect of comprehensive management for large diffuse adenomyosis (LDAM)by using conservative surgery combined with GnRH-a and levonorgestrel-releasing intrauterine system (LNG-IUS).Methods Fourteen patients with LDAM were treated by using comprehensive treatment with abdominal conservative surgery combined with GnRH-a and LNG-IUS at the Affiliated Obstetrics and Gynecology Hospital of Fudan University between March 2009 and September 2011.Subcutaneous injection of 3.6-mg goserelin was performed in all patients for 3 months,and then conservative surgery was performed.Then,the GnRH-a treatment was continued for 3 months;with follow-up of 48 months.During the GnRH-a injection,the traditional Chinese medicine Kuntai capsule and Caltech D tablets were given to reduce symptoms of low estrogen level and bone loss.The treatment effects,menstrual pattern,and side effects were observed for 48 months.Before and after the GnRHa treatment,every 3 months in the first year,every 6 months in the second and third year,and at the end of the fourth year after placement of Mirena,the curative effect,menstrual pattern,and side effects were observed.Results After long-term comprehensive management 12 cases finished the follow-up,the uterine volume was significantly reduced (from 410.6 cm3 to 166.3 cm3),the endometrial thickness was significantly thinner (from 8.3 mm to 6.2mm),dysmenorrhea scores were reduced (from 8.6 to 2.9),and hemoglobin level increased significantly (from 75.0 g/L to 142.1 g/L),and serum CA125 level decreased significantly(from 78.9 kU/L to 27.1 kU/L).The menstrual pattern characterized by irregular vaginal bleeding was improved and tended to be regular.Menstrual quantity decreased and tended to be oligomenorrhea or amenorrhea.In two patients,the implanted LNG-IUS was replaced with a new one after 6 years.One patient had ring off after 18 months,and another patient had the LNG-IUS removed after 36 months and was impregnated naturally.The main side effects were expulsion of LNG-IUS,ovarian cysts,weight gain,acne,and breast tenderness.Conclusion Long-term comprehensive management for large diffuse adenomyosis by using conservative surgery combined with GnRH-a and LNG-IUS is effective and feasible.