| Toshisuke Saito, M.D.* Mitsuyoshi Nagae, M.D.* Yokohama, Japan |
Abstract :
An entirely new conservative surgery was performed on 185 adenomyosis patients for which favorable results had not been obtained with conservative treatments, including hormonotherapy.
Magnetic resonance imaging (MRI) was used in pre-operative diagnosis for all cases to determine surgical procedure, and in post-oprative diagnosis to evaluate surgical results in the 138 cases for which six months had elapsed. In nearly all cases, menstruation recovered within a few months, and a remarkable improvement in symptoms was detected. A reduction was observed in the CA-125 value in all 138 cases(p=5.74 X10-42),Hb increased in 126 of 138 cases(p=3.86 X10-25), and all anemic patients returned to normal following the operation.
Introduction :
Adenomyosis uteri has generally been treated with hormonotherapy, obtaining
relatively satisfactory results in most cases. In those cases refractory to hormonotherapy,
simple total hysterectomy (STH) has typically been recommended.According to current
medical literature, STH is considered to be the principal diagnostic and therapeutic
technique for adenomyosis.
Nevertheless, STH is believed to have significant psychological and endocrinological
problems associated with it, and hence there is a need to explore treatment alternatives.
In this report, we describe an entirely new conservative surgery for adenomyosis
uteri which enabled near-complete recovery of menstruation in 183 out of 185 cases.
Materials and Methods :
Patients.The new method was applied to 600 in-patients who had been diagnosed in our clinic during the period from September, 1988 to September, 1991 as having myoma and or adenomyosis and requiring surgery. This report focuses on 185 of these cases in which their disease was later determined to be adenomyosis as a result of post-operative histopathological examinations. Before visiting our clinic, all of the patients has been told by doctors in other major hospitals that there were no treatment measures available other than STH. The patients ranged in age from 27 to 50 years (mean±SD=41.1±5.6), with mean parity of 0.84±1.05 (SD), and mean gravida of 1.81±1.71(SD).
Surgical preparation. All 185 patients were subjected to pre-operative general examinations including magnetic resonance imaging (MRI), computerized tomography (CT), ultrasonography (US), and CA-125 measurement, as well as cancer check up on the cervix uteri and endometrium. The 138 cases for which at least six months had elapsed since surgery were also subjected to a post-oprative general examination with MRI and CA-125 tests. In all cases, MR imaging was performed under conditions of T2-weighting and SE of 2200/100.
Data analysis. Pre- and post-operative values for CA-125, RBC, Ht and Hb for the 185 patients were compared by the two-tailed sign test.
