Comments :

It is noted that many patients show a strong aversion to STH, irrespective of marital status or pregnancy history. Many studies report that STH has been the cause of a variety of post-operative complaints, even leading to depression. Meanwhile, from an endocrinological viewpoint, other studies have reported the occurrence of ovarian failure after STH, even with ovarian conservation. The new conservative surgery described in this report avoids such drawbacks while enabling remarkable recovery. CA-125 examinations showed that this surgery led to a significant reduction in measured values in all of the cases. A remarkable improvement in symptoms was observed by us and reported by the patients, as well. Menstruation became normalized in all cases, with anemia also improving in all anemic cases.

Furthemore, it has been suggested that hormonotherapy is generally effective. Yet, it involves numerous side effects with many refractory cases. The surgery reported here is noteworthy for the fact that it requires no post-operative therapy such as hemafacient or hormonal medicines and is not accompanied by any major side effects. In all cases menstruation began within a few months, and blood loss was normalized as suggested by patient comments and CBC values. A follow-up survey of the patients showed that in two cases among the 185 which underwent our surgery, total hysterectomy was later performed by other doctors due to post-operative complications.

Operative bleeding was noted occassionally in the early cases, but has rarely occurred more recently. This is considered to be thorough execution of excision and suture so that dead space is eliminated.

MRI has been found useful for enabling diagnosis of adenomyosis prior to operation. It can indicate the location of the affected area and its form against the endometrium, and provides information on myoma complications. Likewise, it makes possible the evaluation of post-operative conditions. On the other hand, diagnosis by ultrasonograph was found to be superior to MRI for adenomyosis in certain cases. Furthmore, in many cases MRI served to detect changes in the endometrium, e.g. soft pedunculated submucosal myomas, polyps, endometrial hyperplasia, etc.

Finally, it is reported that in many cases adenomyosis coexists with endometrial cancer, especially in older women.
However, our pathological report includes only one case of endometrial carcinoma in situ among the 185 cases. This is attributable to the patients' relatively young age distribution, to their race, and to the fact that the patients had been screened by many years of cancer check-ups made in general practice before visiting us for consultation. Regarding follow-up for post-operative malignancy, we believe that the same methods may be used as in adenomyosis cases treated with traditional hormonotherapy.

Table I.

Statistical summary of pre-and post-operative values for CA-125, RBC, Ht and Hb. Comparisons made by two-tailed sign test (n=138)

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