Application value of focused ultrasound ablation surgery in patients with adenomyosis who have a desire for fu-ture fertility
Objective To evaluate the pregnancy outcomes of patients with adenomyosis treated with focused ultrasound ablation surgery(FUAS)and analyze the influencing factors of pregnancy outcomes.Methods Totally 393 patients with adenomyosis who had a desire for future fertility completed FUAS at Chongqing Haifu Hospital and Suining Central Hos-pital of Sichuan from October 2010 to October 2023.These patients were included in the study and were followed up regu-larly after FUAS to record the improvement of symptoms and related reproductive information.The numeric rating scale(NRS)was used to evaluate dysmenorrhea,and the pictorial blood loss assessment chart(PBAC)was used to assess the menstruation volume.The patients were divided into pregnancy group and no-pregnancy group,and the pregnancy group was again divided into successful delivery group and abortion group.The related indi-cators influencing pregnancy were compared.Re-sults(1)Improvement in symptoms of dysmenor-rhea:The NRS score in all patients was significant-ly decreased from 7.0(4.0,8.0)to 3.0(2.0,5.0)points at 3 months after FUAS(P＜0.05).(2)Im-provement in menstruation:The PBAC score in all patients was also significantly decreased from 135(105,135)to 105(55,105)at 3 months after FUAS(P＜0.05).(3)Pregnancy after treatment:After a follow-up of(69.4±22.2)(range:11.0-144.0)months,199 pregnancies in 170 patients were observed,and the pregnancy rate was 43.3％(170/393).Among them,129 patients conceived naturally and 41 conceived by in vitro fertilization embryo transfer(IVF-ET).Of the 179 infertile patients,58(32.4％)were pregnant after FUAS.Multiple logistic regression analysis showed that pelvic adhe-sion and infertility history were independent risk factors for pregnancy in patients with adenomyosis(OR＜1,P＜0.05).The larger the adenomyotic lesion volume,the less possibility the pregnancy(OR＜1,P＜0.05).No uterine rupture oc-curred during pregnancy or delivery.(4)The uterine volume,the adenomyotic lesion volume and the ablation volume in the abortion group were significantly larger than those in the successful delivery group(P＜0.05).Conclusion FUAS can significantly improve symptoms of patients with adenomyosis.FUAS has a positive effect on fertility in patients with adenomyosis.
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