高强度聚焦超声消融治疗子宫腺肌病后早期子宫浆肌层损伤的MRI评价及影响因素分析

目的研究高强度聚焦超声消融治疗子宫腺肌病术后子宫浆肌层损伤的早期磁共振成像(MRI影像学特征并分析影响因素。方法回顾性分析采用高强度聚焦超声消融治疗子宫腺肌病的患者105例,通过术后磁共振影像评价,将其分为无损伤组(83例)及损伤组(22例),通过单因素及logistic回归分析影响因素。结果高强度聚集超声消融治疗后子宫腺肌病病灶所在肌壁的浆肌层有损伤时,表现为MRI强化时出现局部缺损。经单因素分析,年龄、病灶类型及消融率比较,差异有统计学意义(P 0.05)。经多因素回归分析,年龄及消融率是高强度聚焦超声消融治疗子宫腺肌病术后子宫浆肌层损伤的影响因素(P 0.05)。结论子宫腺肌病超声消融治疗后早期会出现MRI可见的子宫浆肌层损伤,且损伤的发生受年龄及消融率两个因素的影响。     

高强度聚焦超声消融联合GnRHa治疗子宫腺肌病的临床研究

目的：将高强度聚焦超声（HIFU）消融与促性腺激素释放激素激动剂（GnRHa）联合用于子宫腺肌病患者的治疗,并结合临床实际探讨其应用价值。方法：将石家庄市第一医院妇产科2015年1月—2018年1月诊治的89例子宫腺肌病患者作为研究对象。将入组病例分为2组：HIFU联合GnRHa组（41例）和单纯HIFU组（48例）,比较2组患者治疗后随访1年的疗效指标。结果：HIFU联合GnRHa组病灶体积缩小率和子宫体积缩小率均大于单纯HIFU组,差异有统计学意义（均P＜0.05）。HIFU联合GnRHa组血红蛋白水平高于单纯HIFU组,差异有统计学意义（P=0.044）。HIFU联合GnRHa组痛经VRS评分亦优于单纯HIFU组,差异有统计学意义（P=0.018）。2组患者血清CA125水平和不良反应发生率比较,差异无统计学意义（均P＞0.05）。结论：与仅采用HIFU消融比较,HIFU联合GnRHa治疗子宫腺肌病能更有效地缩小病灶体积和子宫体积,同时改善血红蛋白水平和痛经症状。     

巨噬细胞CD68与子宫腺肌病发病机制的关系

目的探讨巨噬细胞CD68与子宫腺肌病发病机制的关系。方法采用免疫组化法检测巨噬细胞CD68在子宫肌瘤、子宫腺肌病、子宫腺肌病合并肌瘤患者病灶及结合带中的表达。结果巨噬细胞CD68在各组病灶及结合带组织的表达情况见表1～表3。①腺肌病组结合带巨噬细胞CD68表达明显高于肌瘤组及正常组结合带,差异有统计学意义(P<0.05);肌瘤组与正常组结合带表达差异无统计学意义(P>0.05);②腺肌病组病灶中巨噬细胞CD68表达较肌瘤组病灶中明显升高,差异有统计学意义(P<0.05);③子宫腺肌病合并子宫肌瘤组腺肌瘤病灶中巨噬细胞CD68表达较肌瘤病灶中明显升高,差异有统计学意义(P<0.05);④子宫腺肌病病灶中巨噬细胞CD68表达较其结合带中明显升高,差异有统计学意义(P<0.05)。结论子宫腺肌症的发病可能与局部的免疫改变、巨噬细胞浸润有关。     

子宫腺肌病患者痛经强度与前列腺素的相关性研究

目的:检测子宫腺肌病患者血浆、腹水与组织匀浆中前列腺素(PGE2、TXB2和6-Keto-PGF1α)的含量,分析其与患者痛经强度的相关性。方法:研究组(子宫腺肌病组)23例,对照组(子宫肌瘤组)23例,研究组患者术前均对痛经强度进行评分,采用放免法测定血浆、腹水与腺肌病病灶、子宫肌层组织匀浆中前列腺素(PGE2、TXB2和6-Keto-PGF1α)的含量。结果:腺肌病组患者血浆PGE2水平显著高于对照组,P<0.05,且与痛经强度评分呈正相关。腺肌病患者月经期血浆前列腺素(PGE2T、XB2和6-Keto-PGF1α)与手术期比较,差异无显著性(P>0.05)。腺肌病组患者腹水中前列腺素(PGE2、TXB2和6-Keto-PGF1α)水平与对照组相比,差异无显著性(P>0.05),且与痛经强度评分无相关性。腺肌灶组织匀浆PGE2含量显著高于腺肌病正常肌层和子宫肌瘤正常肌层,P<0.05,腺肌灶PGE2T、XB2和6-Keto-PGF1α含量均与痛经强度评分呈正相关。结论:腺肌病病灶局部PGs合成异常增多是导致痛经的重要原因之一。     

子宫腺肌病患者内膜组织中PTTG的表达及与MMP-2和TIMP-1的关系

目的:检测子宫腺肌病患者内膜组织中垂体肿瘤转化基因(PTTG)的表达,并分析其与基质金属蛋白-2(MMP-2)、基质金属蛋白酶组织抑制因子-1(TIMP-1)的柑关性.方法:采用免疫组化SP方法检测35例子宫腺肌病组、在位内膜组和24例非子宫腺肌病患者正常内膜组中PTTG、MMP-2及TIMP-1蛋白的表达水平.结果:①PTTG在子宫腺肌病组、在位内膜组和正常内膜组间的表达差异有高度统计学意义(P＜0.001),其中子宫腺肌病组和在位内膜组表达强度显著高于正常内膜组(P＜0.001),子宫腺肌病组与在位内膜组间差异无统计学意义(P＞0.05);②MMP-2在子宫腺肌病组和在位内膜组中的表达强度高于正常内膜组(P＜0.05);③TIMP-1在子宫腺肌病组中的表达比正常内膜组低,两组相比差异有高度统计学意义(P＜0.001);④PTTG与MMP-2的表达呈正相关,与TIMP-1的表达无相关性.结论:子宫腺肌病内膜中PTTG高表达,导致MMP-2表达上调,并可能影响TIMP-1的表达,从而使子宫内膜的增殖活性增强、侵袭力增高,致使子宫内膜向下浸润性生长,提示PTTG参与了子宫腺肌病的发生.     

两种手术方式对子宫腺肌病患者性生活满意度影响对比分析

目的探讨腹腔镜下子宫腺肌病病灶剔除联合子宫动脉阻断术和全子宫切除术两种手术方式对子宫腺肌病患者术后性生活满意度的影响。方法选择2011年6月至2013年10月间湖北省妇幼保健院收治的年龄40~46岁,有明确手术指征并自愿选择手术治疗的子宫腺肌病患者65例,采取知情并自愿原则入组,其中子宫腺肌病病灶切除联合双侧子宫动脉阻断术组(剔除组)32例,全子宫切除术组(全宫组)33例。对两组患者术后6个月、12个月性生活满意度进行调查并对比分析。结果剔除组与全宫组均有较高的治疗满意度(81.25%、84.85%)且差异无统计学意义(P0.05)。组内比较,剔除组术后性生活满意度较术前明显提高(术前,术后6、12个月性生活满意度分别为59.37%、87.50%、86.67%),差异有统计学意义(P0.05)。全宫组术后性生活满意度较术前无明显改变(术前,术后6、12个月性生活满意度分别为60.61%、60.61%、56.67%)。组间同期比较,剔除组术后性生活满意度均高于全宫组,差异有统计学意义(P0.05)。结论采用腹腔镜下子宫腺肌病病灶剔除联合子宫动脉阻断术治疗子宫腺肌病有利于患者术后心理和生理的平稳过渡及全面康复,在提高患者术后性生活满意度方面更有优势。     

子宫腺肌病神经纤维的分布及其临床意义

目的:探讨子宫腺肌病病灶中神经纤维的分布及其与临床痛经的关系。方法:选择经手术切除子宫的患者64例,其中腺肌病组40例,对照组24例。分别用抗S-100蛋白、P物质(SP)、神经丝蛋白(NF)、神经元特异性烯醇化酶(NSE)和神经蛋白基因产物9.5(PGP9.5)抗体应用免疫组化法检测子宫肌层神经纤维的分布。结果:子宫腺肌病组与对照组子宫平滑肌组织中SP表达阳性率及阳性神经纤维密度分别为70%(28/40)和(0.70±0.32)条/mm2、29.1%(7/24)和(0.24±0.21)条/mm2。腺肌病组病灶中SP阳性神经纤维密度及阳性率均显著高于对照组,差异均有统计学意义(P均<0.05);子宫腺肌病组与对照组子宫平滑肌组织中NF表达阳性率及阳性神经纤维密度分别为92.5%(37/40)和(1.44±0.98)条/mm2、20.8%(5/24)和(0.31±0.29)条/mm2。腺肌病组病灶中NF阳性神经纤维密度及阳性率均显著高于对照组(P均<0.05);腺肌病组病灶中NF阳性神经纤维密度与患者疼痛程度呈正相关关系(r=0.703,P<0.05)。而S-100,NSE,PGP9.5阳性的神经纤维密度及阳性率在两组中差异无统计学意义(P均>0.05)。结论:子宫腺肌病NF和SP免疫反应阳性神经纤维可能参与腺肌病痛经的发生。     

子宫腺肌病/卵巢异位囊肿炎性压力及其与临床特征相关性研究

目的:系统探讨子宫腺肌病/卵巢异位囊肿患者外周血炎性指标变化及其与临床特征的相关性,为子宫腺肌病/卵巢异位囊肿抗炎治疗提供依据。方法:选取来自同济大学附属杨浦医院收治的子宫腺肌病手术患者58例(子宫腺肌病组)、卵巢异位囊肿手术患者37例(卵巢异位囊肿组),健康女性47例(对照组),于增生期抽取外周血,检测血清炎性细胞因子和肿瘤相关抗原浓度,分析炎性压力与临床特征的相关性。结果:子宫腺肌病组外周血中性粒细胞(Neu)、Neu%、中性粒细胞与淋巴细胞比值(NLR)、白细胞介素6(IL-6)、IL-8、CA199、CA125高于对照组,差异有统计学意义(均P0.05);子宫腺肌病组外周血血红蛋白(HGB)低于对照组,差异有统计学意义(Z=688.50,P=0.00)。卵巢异位囊肿组外周血Neu、Neu%、NLR、IL-6、IL-8、肿瘤坏死因子-α(TNF-α)、CA199和CA125高于对照组,差异有统计学意义(均P0.05)。子宫腺肌病中度痛经组外周血白细胞(WBC)、CA125高于轻度痛经组,差异有统计学意义(均P0.05)。子宫腺肌病重度痛经组外周血WBC、Neu、Neu%、NLR、IL-8和IL-6高于中度痛经组,差异有统计学意义(均P0.05)。子宫腺肌病重度痛经组外周血WBC、Neu、Neu%、NLR、IL-6、IL-8和CA125高于轻度痛经组,差异有统计学意义(均P0.05)。子宫腺肌病中、重度痛经组外周血HGB低于轻度痛经组,差异有统计学意义(均P0.05)。子宫腺肌病经量过多组外周血WBC、Neu、Neu%、NLR、IL-6、IL-8和CA125高于正常月经组,差异有统计学意义(均P0.05)。卵巢异位囊肿重度痛经组外周血IL-6、IL-8高于轻度、中度痛经组,差异有统计学意义(均P0.05)。子宫内膜异位症患者肿瘤指标与外周血炎性指标在统计学上无明显相关性。结论:子宫腺肌病/卵巢异位囊肿处于全身炎症压力状态,并与临床特征相关,为子宫内膜异位症抗炎治疗提供了依据。     

整合素连接激酶在子宫腺肌病中的表达及临床意义

目的:研究整合素连接激酶(ILK)在子宫腺肌症患者内膜及肌层组织中的表达及其临床意义。方法:选取2013年10月至2014年5月在山东大学齐鲁医院妇科行子宫切除术的53例患者,其中子宫腺肌病32例(腺肌病组),子宫肌瘤和宫颈上皮内瘤变21例(对照组)。采用免疫组化SP法检测ILK在对照组内膜、肌层,腺肌病组在位内膜、异位内膜及病灶肌层中的表达。采用Image-Pro Plus 6.0图像处理系统进行图像分析。结果:(1)腺肌病组在位内膜腺上皮及间质细胞中ILK表达均明显高于异位内膜及对照组正常内膜(P<0.05),且腺上皮细胞ILK的表达量与痛经程度呈明显正相关(r=0.571;P<0.05);异位内膜与对照组正常内膜比较,差异无统计学意义(P>0.05)。(2)腺肌病组内膜(在位及异位)腺上皮及间质细胞ILK的表达量均无周期性变化(P>0.05)。对照组内膜间质细胞ILK表达量增殖期较分泌期明显增加(P<0.05),腺上皮细胞ILK表达量无周期性变化(P>0.05)。(3)腺肌病组病灶肌层中ILK表达量明显高于对照组肌层(P<0.05),并与痛经程度及子宫大小呈正相关(r=0.362;P<0.05;r=0.555,P<0.05)。(4)腺肌病组病灶肌层增殖期的ILK表达水平明显高于分泌期(P<0.05),对照组肌层中ILK表达无周期性变化(P>0.05)。结论:子宫腺肌病患者在位内膜及病灶肌层组织中ILK表达显著增强,提示ILK在子宫腺肌病的发生发展中可能具有重要作用。     

Ras/Raf/P-C-Raf在子宫腺肌病中的表达及意义

目的:检测Ras/Raf/P-C-Raf在子宫腺肌病在位内膜、异位病灶组织中的表达水平,以及阻断Ras表达后病灶细胞抑制率的变化,探讨Ras/Raf/P-C-Raf在子宫腺肌病中的发病机制。方法:收集子宫腺肌病患者的病灶组织或石蜡切片,Western blot法、免疫组化法检测Ras、Raf及P-C-Raf在子宫腺肌病组织中的表达水平;体外培养子宫腺肌病病灶细胞,CCK-8法检测FTS组(Ras抑制剂)及FTS+E2组细胞生长抑制率。结果:Ras、Raf主要表达定位于胞浆与胞膜。与对照组子宫肌层及内膜相比,子宫腺肌病异位病灶、在位内膜中Ras、Raf表达水平均明显升高(P0.05);子宫腺肌病在位内膜P-C-Raf水平较异位病灶及正常子宫内膜组高(P0.05)。FTS组、FTS+E2组均能抑制子宫腺肌病病灶细胞增殖,其中FTS+E2组的细胞抑制率较FTS组高,差异有统计学意义(P0.05)。结论:通过抑制Ras表达证实子宫腺肌病异位病灶及在位内膜过高表达的Ras/Raf及在位内膜P-C-Raf过表达促进子宫腺肌病病灶细胞增殖,参与子宫腺肌病的发生发展。其中E2促进病灶细胞增殖效应的途径之一可能通过Ras发挥作用。     

HIFU联合地诺孕素治疗子宫腺肌病的疗效观察

目的 观察高强度聚焦超声(HIFU)联合地诺孕素治疗子宫腺肌病的临床疗效.方法 选取120例子宫腺肌病患者,根据随机数字表法分为单纯HIFU组、HIFU联合促性腺激素释放激素激动剂(GnRHa)组及HIFU联合地诺孕素组,每组40例.单纯HIFU组采用HIFU治疗,HIFU联合GnRHa组采用HIFU联合GnRHa治疗...     

促性腺激素释放激素激动剂治疗不孕症合并子宫腺肌病

目的 探讨促性腺激素释放激素激动剂(GnRH-α)对不孕症合并子宫腺肌病的疗效。方法 对12例不孕症合并子宫腺肌病行GnRH-a治疗,每月肌注抑那通3.75mg,连用6个月,同时加用利维爱作“反向添加治疗法”;停用GnRH-a后,部分病例应用促排卵和官腔内受精(IUI)。治疗前、后分别进行B超、核磁共振(MRI)检查,血清CA_(125)、生殖激素(FSH、LH、E_2)及骨密度(BMD)测定。结果 治疗后痛经等症状缓解,B超和MRI提示子宫腺肌病病灶基本消退,子宫大小恢复正常占83.33％(10/12),血CA_(125)、FSH、LH、E_2水平显著降低(P<0.01),腰椎BMD无明显变化(P>0.05),妊娠率达75.0％。结论 CnRH-α是治疗不孕症合并子宫腺肌病的一种有效方法,辅助诱导排卵和IUI,妊娠率进一步提高;应用GnRH-α时,可加用适量的激素补充疗法。     

左炔诺孕酮宫内缓释系统(LNG-IUS)治疗子宫腺肌病中远期临床效果的研究

目的:探讨子宫腺肌病(AM)患者放置左炔诺孕酮宫内缓释系统(LNG-IUS)后的中远期临床效果。方法:对48例AM患者放置LNG-IUS,记录放置前1个月、放置后第1年、第1.5年、第3年、第5年的痛经、月经量、子宫内膜厚度变化,同时阴道超声测量子宫大小及双侧卵巢体积等各项指标。放置LNG-IUS第1年、第1.5年及第3年、第5年抽取晨血查生殖内分泌激素水平及肝肾功能。结果:放置LNG-IUS后至少完成1年随访43例,随访率89.58%,平均随访50个月。43例患者术后痛经改善,临床有效率83.72%,与置LNG-IUS前比较,有统计学差异(P<0.01);子宫体积放置后1.5年与放置前比明显缩小(P<0.05);第3年、第5年缩小更明显(P<0.01)。放置后子宫内膜厚度明显变薄(P<0.01);生殖激素无明显变化。结论:LNG-IUS用于治疗子宫腺肌病具有较好的中远期效果。     

左炔诺孕酮宫内缓释系统治疗子宫腺肌病的临床观察

目的探讨左炔诺孕酮宫内缓释系统(LNG-IUS;商品名:曼月乐)治疗子宫腺肌病的临床疗效。方法对42例根据临床症状、彩色超声或MRI检查、腹腔镜或开腹手术诊断为子宫腺肌病的患者,宫内放置LNG-IUS,观察月经量、痛经程度及子宫体积变化。结果放置LNG-IUS后3个月,月经量显著减少,治疗3个月时的月经量降低为治疗前的(27±11)%,治疗前后比较,差异有统计学意义(P<0.01);治疗前子宫体积为(143±33)cm3,治疗3个月时子宫体积为(115±22)cm3,治疗前后比较,差异也有统计学意义(P<0.05);42例患者痛经症状显著缓解或完全消失;20例贫血患者血红蛋白水平从治疗前的(86±14)g/L恢复至治疗后的(124±8)g/L。结论LNG-IUS治疗子宫腺肌病近期疗效显著。     

Minimally invasive treatment of adenomyosis

The aim of the present review is to give a comprehensive overview of minimal invasive treatment options and suggest a minimally invasive approach in women with adenomyosis (AD).A review of relevant literature on medical and surgical treatment options is performed. Surgical options include endometrial ablation, hysteroscopic endometrial and adenomyoma resection, laparoscopic resection of AD, high-intensity focused ultrasonography (HIFU), and uterine artery embolization (UAE).This review summarizes treatment strategies for the management of AD and highlights the present lack of knowledge, which makes suggestions of evidence-based treatment difficult.     

子宫腺肌症患者子宫次全切除术后的危险性探讨

目的 :探讨子宫腺肌症患者子宫次全切除术后的危险性 ,为临床子宫腺肌症患者手术方式的选择提供指导。方法 :对子宫腺肌症患者行子宫次全切除术标本的子宫体下切缘进行常规病理组织学检查。结果 :子宫体下切缘子宫内膜异位病灶 (切缘阳性 )的发生率为 12 %。切缘阳性子宫腺肌症患者的子宫肌层最大厚度、临床症状以及是否合并子宫内膜异位症与切缘阴性的子宫腺肌症患者差异无显著性 (P >0 .0 5)。但切缘阳性子宫腺肌症患者的宫体纵形长度明显小于切缘阴性者 (P <0 .0 5)。结论 :子宫腺肌症患者的病程较长 ,病变弥漫、痛经明显且时间较长、合并子宫内膜异位症可能是子宫体下切缘阳性的高危因素 ,手术时切口过高是子宫体下切缘阳性的直接因素。子宫腺肌症患者如年龄较大同时存在高危因素 ,则应行全子宫切除术 ,如行子宫次全切除术 ,切口位置应尽量低 ,而且应对子宫体下切缘行病理组织学检查     

500 Cases of High-intensity Focused Ultrasound (HIFU) Ablated Uterine Fibroids and Adenomyosis

ObjectiveClinical outcomes of 500 high-intensity focused ultrasound (HIFU)-treated uterine fibroids and adenomyosis are analyzed and presented.Materials and methodsThis is a retrospective cross-sectional analysis from a single tertiary medical center. From April 2015 to October 2018, 546 cases were enrolled for the study. After excluding 46 patients with less than 3 months of follow-up period, there were 404 fibroids, 149 adenomyosis and 53 mixed conditions entered for analysis. The patients’ uterine fibroids and adenomyosis were treated by HIFU according to Chongqing Haifu protocol, with 12 cm diameter transducer of focal length 10–16  cm at 0.8 or 1.6 MHz T2-weight MRI imaging was rendered prior to and 3 month post treatment to assess lesion volume change using non-perfusion volume, which was the primary outcome. Secondary outcomes including quality of life, subjective satisfaction, adverse events and pregnancy rate were determined using self-reported questionnaires. The mean follow up period ranged from 3 to 38 months with an average of 21 months.ResultsThree months after HIFU-treated uterine fibroids and adenomyosis, the lesion size reduced 40.2% and 46.3%, respectively. Symptoms all improved with better quality of life for the fibroid group, while those with adenomyosis or combined diseases benefit the most from pain control. Serum CA125 decreased significantly for all studied groups, and LDH only showed improvement for fibroids group. Number of adverse events is comparable to Chongqing data (approximately 10.2%), with mostly mild and self-resolving conditions. No permanent sequelae or death was documented. Twelve pregnancies are reported in this cohort.ConclusionHIFU is safe and effective in treating uterine fibroids and adenomyosis. The results are reproducible if standardized treatment schedules are followed. It is a promising treatment alternative with the advantages of precision, non-invasiveness, rapid recovery and readiness for pregnancy.     

Pretreatment bowel manipulation during ultrasound-guided high-intensity focused ultrasound therapy for posterior wall uterine masses

ObjectiveHigh-intensity focused ultrasound (HIFU) therapy is a noninvasive alternative to conventional abdominal surgery in obstetrics and gynecology. The aim of this study is to evaluate the reduction of pain intensity with bowel manipulation before ultrasound-guided HIFU treatment in women with posterior wall uterine fibroids and/or adenomyosis.Materials and methodsThis is a multicenter retrospective observational study. Data from all patients who underwent HIFU therapy at three HIFU clinics (Sichuan Maternal and Child Health Hospital, Xiangya Hospital of Central South University, and Kuo General Hospital) between January 2019 and December 2019 were analyzed. We compared pain intensity with and without bowel manipulation during the HIFU treatment and evaluated tolerability without intravenous sedation. The presence of discomfort or pain during the HIFU procedure was evaluated using the visual analog scale (VAS).ResultsA total of 86 women were included in this study. All women underwent HIFU therapy with the PRO-2008 system in the supine position for posterior wall uterine fibroids and/or adenomyosis. Thirty-seven women received pretreatment anal catheterization with a condom and 49 women were not subjected to bowel manipulation. All patients received pretreatment condom-catheter device were well tolerated during the procedure of bowel manipulation. During the HIFU procedure, the women who had received bowel manipulation experienced lower pain intensity, especially less sacrococcygeal pain (VAS score 1.56 ± 1.46 vs 2.89 ± 1.61), target region pain (1.54 ± 1.30 vs 2.53 ± 1.29), and radiating pain (0.13 ± 0.34 vs 0.41 ± 0.54), compared with the women without bowel manipulation.ConclusionBowel manipulation with anal catheterization before HIFU therapy for posterior wall uterine masses can be safely performed and is effective as a low risk intervention to aid in reducing potential HIFU complications related to nerve involvement.     

Is High-intensity Focused Ultrasound Effective for the Treatment of Adenomyosis? A Systematic Review and Meta-analysis

Study ObjectiveTo systematically review the literature regarding the efficacy of high-intensity focused ultrasound (HIFU) in reducing adenomyotic lesions, patients’ pain and bleeding symptoms, and the impact on patients’ quality of life.Data SourceA search was performed through PubMed/MEDLINE and Cochrane databases.Methods of Study SelectionAll available studies published in the English language in the last 10 years that evaluated the effects of HIFU for adenomyosis.Tabulation, Integration, and ResultsA systematic review was performed following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. A meta-analysis was performed on data from homogeneous studies. Pooled results from the meta-analysis showed that after HIFU treatment for adenomyosis, a large effect was observed in reducing the uterine volume at 12 months (standard mean difference [SMD] = 0.85), a significant reduction in dysmenorrhea at 3 months (SMD = 1.83) and 12 months (SMD = 2.37), and a significant improvement in quality of life at 6 months (SMD = 3.0) and 12 months (SMD = 2.75). Adverse reactions after HIFU were reported in 55.9% of patients.ConclusionThis review suggests a potential benefit for HIFU in the treatment of adenomyosis-related symptoms; however, findings of the meta-analysis were based on fewer, nonuniform studies, which did not equally account for each specific symptom/parameter across the board. Results showed there appears to be a potential of HIFU in the treatment of adenomyosis-related symptoms. To date, there are no comparative and randomized clinical trials comparing the HIFU technique with other conservative treatment options. As yet, there are insufficient data regarding fertility and pregnancy outcomes.