Study on the Effect of GnRH-a Pretreatment Combined with High Intensity Focused Ultrasound in the Treatment of Adenomyosis
Objective:To investigate the effect of gonadotropin releasing hormone agonist(GnRH-a)pretreatment combined with high intensity focused ultrasound in the treatment of adenomyosis.Methods:298 patients with adenomyosis admitted to our hospital from January 2019 to May 2021 were randomly divided into the control group and the experimental group using a random number table method,with 149 patients in each group.The control group received high intensity focused ultrasound treatment,while the experimental group received GnRH-a pretreatment,after 2 consecutive menstrual cycles,high intensity focused ultrasound treatment was combined.Both groups were followed up for 2 years after treatment.The lesion volume,uterine volume,menstrual volume,pain level,levels of hor-mones,serum cytokine before and 3 months after treatment,adverse reactions during treatment,recurrence and pregnancy outcomes dur-ing followed up between the two groups were compared.Results:Compared with before treatment,after 3 months of treatment,the lesion volume and uterine volume of the two groups decreased,experimental group was smaller(P＜0.05);the menstrual volume,score of numeric rating scale(NRS),serum levels of estradiol(E2),luteinizing hormone(LH),follicle stimulating hormone(FSH),and transforming growth factor β2(TGF-β2),vascular endothelial growth factor(VEGF)of the two groups decreased,the experimental group compared to the con-trol group was lower(P＜0.05);the level of serum adiponectin(ADP)increased in both groups,experimental group was higher(P＜0.05).There was no significant difference in the incidence of sacrococcygeal pain,radiating pain,lower abdominal pain,and irregular vaginal bleeding between the experimental group and the control group during the treatment period(P＞0.05);the recurrence rate and abortion rate during the followed up period in the experimental group were 6.04％and 10.58％,respectively,lower than the control group's 17.45％and 35.21％(P＜0.05);the clinical pregnancy rate during the followed up period in the experimental group was 69.80％,which was higher than 47.65％in the control group(P＜0.05).Conclusion:GnRH-a pretreatment combined with high intensity focused ultrasound could reg-ulate levels of hormone and serum cytokine in patients with adenomyosis,reduce lesion volume and uterine volume,reduce menstrual flow,alleviate pain,and improve pregnancy outcomes,with good safety.
Adenomyosis of the uterusGonadotropin releasing hormone agonistsHigh intensity focused ultrasoundHormonesDegree of painPregnancy outcome
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