子宫动脉栓塞与子宫肌瘤剔除术治疗子宫肌瘤疗效对比分析

目的探讨子宫肌瘤子宫动脉栓塞治疗与子宫肌瘤剔除术治疗疗效.方法回顾分析40例(A组)经子宫动脉栓塞治疗、42例(B组)经腹腔镜子宫肌瘤剔除术、36例(C组)经阴式子宫肌瘤剔除术及30例(D组)经腹式子宫肌瘤剔除术治疗子宫肌瘤病例临床资料及随访情况,分析疗效.结果4组病例均保留子宫,临床症状均明显改善,且未出现明显并发症.术后随访3～24 个月(平均18个月),术后6个月,A组子宫及肌瘤体积缩小平均62%,6例肌瘤消失;B、C、D组子宫体积缩小平均84%.术后18个月,A组子宫及肌瘤体积缩小平均86%,子宫体积恢复正常大小23例,14例肌瘤消失,B、C、D组子宫体积恢复正常大小分别为30例、29例、23例,肌瘤复发分别为3例、2例、2例.结论子宫动脉栓塞治疗与子宫肌瘤剔除术治疗子宫肌瘤均有良好疗效,子宫肌瘤剔除术治疗子宫肌瘤后子宫体积恢复正常大小及肌瘤消失率较子宫动脉栓塞治疗法高,但近期复发率高于子宫动脉栓塞治疗法.     

促性腺激素释放激素激动剂治疗子宫肌瘤近期疗效观察

目的 :探讨促性腺激素释放激素激动剂 (Gn RH- a)在治疗子宫肌瘤中的作用。方法 :75例子宫肌瘤患者用Gn RH- a皮下注射 3个月 ,比较治疗前后症状、子宫和肌瘤的体积、血生殖激素水平、子宫血流阻力变化。结果 :子宫及肌瘤体积较治疗前缩小 (P<0 .0 5 )。肌瘤体积缩小≥ 2 0 %以上的病例 6 5例 (86 .6 % ) ,血生殖激素水平明显下降 ,子宫动脉及肌瘤血管阻力指数增加 (P<0 .0 5 )。结论 :Gn RH- a通过降低内生殖激素水平 ,减少子宫血流而发挥其治疗子宫肌瘤的作用。     

经导管子宫动脉栓塞术治疗子宫肌瘤的临床观察

目的 探讨经导管子宫动脉栓塞（TUAE）治疗子宫肌瘤的疗效及安全性。方法 对38例子宫肌瘤患者经导管子宫动脉注射碘油－平阳霉素乳剂行TUAE治疗,其中5例于栓塞后1－3周行全子宫切除或肌瘤剔除术,标本送病理检查;对33例随访6－12个月者,观察肌瘤与子宫体积变化及卵巢内分泌功能改变。结果 行TUAE后,患者总的症状改善率为90．6％（29／32）,其中月经完全恢复正常为90．3％（28／31）,下腹部、腰腿胀痛消失为83．3％（25／30）,尿频、尿急等压迫症状消失为45．5％（5／11）。栓塞6个月后,肌瘤与子宫体积平均缩小为59．1％和49．3％,栓塞12个月后平均缩小为61．8％和49．9％。卵巢内分泌功能栓塞前后无显著变化。手术标本病理学检查,碘油仅分布于肌瘤组织,栓塞2周后肌瘤组织出现点状坏死,3周后出现大量片状坏死,而正常子宫肌组织未见异常。结论 行TAUE治疗子宫肌瘤,近期疗效明显,对卵巢内分泌功能及正常子宫肌组织无明显影响。     

子宫动脉栓塞治疗子宫肌瘤远期疗效随访评价

目的:评价子宫动脉栓塞治疗子宫肌瘤的远期疗效.方法:子宫动脉栓塞治疗子宫肌瘤并接受术后完整随访3年以上的患者共45例,随访子宫肌瘤变化和症状缓解情况、卵巢功能和术后生命质量.结果:治疗后3例子宫粘膜下肌瘤和5例直径小于3.0 cm的肌壁间肌瘤消失,3例无效,45例肌瘤体积平均缩小65%,未发现肌瘤复发,临床症状减轻或完全消失;除3例闭经外的42例治疗前后激素水平差异无统计学意义;治疗后6月生命质量初步改善,7～12月显著改善,12月以后处于稳定期.结论:子宫动脉栓塞治疗子宫肌瘤能使肌瘤体积明显缩小并缓解症状,对40岁以下患者的卵巢功能无明显影响,术后生命质量提高.     

双侧子宫动脉栓塞治疗妇产科疾病的疗效观察

目的分析双侧子宫动脉栓塞治疗育龄期子宫肌瘤的疗效。方法选取我院2014年5月~2015年5月收治的育龄期子宫肌瘤患者45例,选择明胶海绵颗粒、平阳霉素乳剂进行治疗。手术后3个月、6个月和12个月进行随访,观察患者疗效、并发症。结果经治疗,所有患者临床症状得以缓解,月经恢复正常42例,手术后对患者进行复查,术后3个月时肌瘤缩小率为36.5%,术后6个月时肌瘤缩小率为56.8%,术后12个月时肌瘤缩小率为76.3%。结论针对子宫肌瘤患者,给予双侧子宫动脉栓塞治疗,可减小肌瘤体积,有效改善临床症状,明显提升疗效。     

瘤内注射无水乙醇治疗子宫肌瘤的临床研究

目的观察彩色多普勒超声引导下经皮瘤内注射无水乙醇(PEIT)治疗子宫肌瘤的疗效。方法对79例子宫肌瘤患者采用超声引导下PEIT治疗,术后3个月、6个月、12个月分别观察肌瘤体积、内部血流及临床症状改善情况。结果PEIT后3个月、6个月、12个月子宫体积和肌瘤体积分别缩小为50.2%、64.3%、67.6%和52.9%、71.9%、73.4%。彩色多普勒血流显示肌瘤内部及周边血流明显减少,月经量明显减少,贫血症状显著改善。结论PEIT治疗子宫肌瘤操作简便、安全有效。     

超声消融治疗子宫肌瘤的安全性及有效性

目的 验证超声消融技术用于子宫肌瘤治疗的安全性、有效性.方法 采用前瞻性、非随机临床研究方法,对重庆医科大学附属第一医院和解放军第三○七医院就诊的99例子宫肌瘤患者(117个肌瘤,肌瘤直径≤10 cm)进行超声消融治疗.仪器为重庆海扶(HIFU)技术有限公司研制的JC型聚焦超声肿瘤治疗系统.治疗在镇静、镇痛下进行,实时超声声像图引导超声消融治疗全过程.治疗后随访期为6个月.治疗后1个月内,行增强磁共振成像(MRI)检查,评价靶肌瘤体积消融率.治疗后3、6个月时,行增强MRI检查,评价靶肌瘤体积缩小率及靶肌瘤体积缩小超过50%的肌瘤占所有肌瘤的百分比.根据子宫肌瘤症状量表(UFS)评价有症状患者的症状评分改善10分者所占比例.依照国际介入放射治疗学会(SIR)标准评价治疗相关的不良反应.结果 (1)有效性:治疗后1个月内,靶肌瘤体积消融率平均为(76±24)%;3、6个月时,靶肌瘤平均体积分别缩小了(45±21)%和(59±26)%,与治疗前比较,差异均有统计学意义(P<0.05).治疗后6个月时,靶肌瘤体积缩小≥50%共99个肌瘤,占84.6%(99/117);UFS症状评分改善10分者占92%(66/72).(2)安全性:全部患者治疗后2 h均可以正常活动.SIR标准中重要不良反应(SIR C～D级:延长住院时间,需要重要治疗,护理等级增加)及严重不良反应(SIR E～F级:永久性后遗症或死亡)的发生率均为0;一般不良反应(SIR A～B级:观察或简单治疗,无不良后果)的发生率为35%(35/99),SIR B级不良反应包括2例声通道皮肤浅Ⅱ度烧伤和2例发热,需要对症治疗及换药处理.其余包括臀部和(或)下肢酸胀痛、阴道分泌异常、排尿困难或疼痛等,均无需治疗,为SIR A级.结论 超声消融技术用于治疗子宫肌瘤是安全、有效的,可以单独用于子宫肌瘤的治疗.     

温度控制和功率控制射频消融治疗子宫肌瘤临床研究

目的 评估温度控制模式和功率控制模式射频消融术治疗子宫肌瘤的安全性和有效性。方法 选择子宫肌瘤192例，随机分为温控模式射频消融组（温控组）和功控模式射频消融组（功控组），两组患者平均年龄、肌瘤平均体积无明显差异。治疗过程采用超声监控，观察两组治疗时间，穿刺消融次数．术中出血量及术后肌瘤体积改变，评价射频消融术治疗子宫肌瘤的可行性及对两种射频消融模式进行比较。结果温控组平均治疗时间为（25．1±5．8）min，功控组平均治疗时间为（22．4±3．5）min，两者差异无显著性（P〉0．05）。温控组术中平均出血量（10±1．3）ml，功控组术中平均出血量（35±5．9）ml，两者差异有显著性（P（0．05）。温控组每个肌瘤平均实施穿刺消融（2．0±1．1）次，功控组每个肌瘤平均实施穿刺消融（4．4土2．6）次，两组差异有显著性（P〈0．05）。随访6个月，温控组有效率为95．7％，功控组有效率为97．6％，两组差异无显著性（P〉0．05）。结论 射频消融术治疗子宫肌瘤是一种疗效肯定，安全可行的微创治疗方法。温控模式下实施射频消融子宫肌瘤，穿刺次数少，出血少，对子宫损伤小。操作风险低。     

两种不同剂量米非司酮治疗子宫肌瘤的疗效观察

目的：观察两种不同剂量米非司酮治疗子宫肌瘤的效果。方法：将４３例有症状的子宫肌瘤患者非随机分为两组进行前瞻性研究。甲组２８例，每天服用米非司酮１０ｍｇ；乙组１５例，每天服用米非司酮２０ｍｇ。从月经第１～３天开始服用，连续服用３个月。于治疗前以及治疗期间的每个月行Ｂ超测量子宫和子宫肌瘤的体积；检查血红蛋白及肝、肾功能。结果：两组患者在治疗期间均闭经，痛经和下腹坠、胀痛症状消失。所有患者的贫血均得以纠正，平均血红蛋白每月上升１４～１６ｇ／Ｌ。用药３个月后，两组子宫及子宫肌瘤体积均明显缩小，甲组肌瘤缩小了４１．４％（Ｐ＜０．０１），乙组肌瘤缩小了４３．０％（Ｐ＜０．０１）；两组之间差异无显著性。两组患者出现的副反应类似。结论：每日口服米非司酮１０ｍｇ是较为理想的治疗剂量，适合于肌瘤较大和（或）严重贫血患者术前准备及围绝经期有症状子宫肌瘤患者的保守治疗     

促性腺激素释放激素激动剂治疗子宫腺肌病26例疗效观察

目的探讨促性腺激素释放激素激动剂(GnRHa)治疗子宫腺肌病的临床疗效。方法2003年1月至2004年1月广州市第一人民医院对26例子宫腺肌病患者予GnRHa3.6mg皮下注射,每4周1次,同时加用利维爱1.25mg/d口服,两者均连用6个月。治疗前后观察月经量、痛经程度及子宫体积等变化,并进行血癌抗原(CA125)、抗子宫内膜抗体(EMAb)及性激素水平测定。结果治疗后随访6个月,26例患者中20例月经量明显减少;痛经程度分级明显降低,痛经缓解率达100%;子宫体积平均缩小56%;血清CA125、EMAb及性激素水平均显著降低;10例不孕患者中治疗后,妊娠率达50%。结论GnRHa能有效控制子宫腺肌病症状,提高妊娠率,并可诱导围绝经期妇女闭经。     

Perforación intestinal tras ablación por radiofrecuencia de mioma uterino. Reporte de caso y revisión bibliográfica

Uterine leiomyoma are the most common pelvic tumours diagnosed in women of reproductive age. In recent years, the search for minimally invasive treatment that allows women to preserve their uterus has resulted in transvaginal radiofrequency ablation. This procedure is safe and effective.We present a case report of intestinal perforation after transvaginal radiofrequency ablation of two uterine leiomyomas. Finally, we present a review of the literature in relation to this complication of the technique.     

射频消融技术对子宫肌瘤组织中ER、PR表达影响的临床试验研究

目的 :开腹直视下射频消融子宫肌瘤后 ,观察射频消融对子宫肌瘤组织中ER、PR表达的影响 ,初探射频治疗子宫肌瘤的机制。方法 :30例需开腹行子宫切除术的多发性子宫肌瘤患者 ,分别用 0 .5cm、1.2cm长的射频自凝刀行肌瘤部位射频消融 ,治疗后立即切除子宫 ,作为试验组 ,并于消融灶中心 (A组 )、边缘 (B组 )、边缘外 1cm(C组 )、边缘外 2cm(D组 )处取材 ,HE染色观察病理变化 ,免疫组化检测ER、PR水平 ;选同一子宫上未做射频治疗的肌瘤组织作为对照组。结果 :射频治疗后 ,消融灶中心肌瘤组织呈凝固性坏死 ,ER、PR无表达 ;消融灶边缘肌瘤细胞变性 ,ER、PR表达减少 (P <0 .0 5 ) ;消融灶边缘外1cm ,肌瘤细胞无变性、坏死 ,但ER、PR表达低于对照组 (P <0 .0 5 ) ;消融灶边缘外 2cm ,ER、PR与对照组差异无显著性 (P >0 .0 5 )。结论 :射频消融技术使肌瘤组织凝固性坏死 ,ER、PR的表达丧失及低表达是射频消融技术能够治疗子宫肌瘤的循证依据     

Optimal cytoreduction after combined resection and radiofrequency ablation of hepatic metastases from recurrent malignant ovarian tumors

BACKGROUND: The role of radiofrequency ablation (RFA) in the treatment of hepatic metastases from recurrent ovarian tumors is undefined. CASE: Three patients with hepatic lesions from recurrent ovarian cancers underwent a combined partial hepatectomy with radiofrequency ablation (RFA) to achieve optimal tumor cytoreduction. Follow-up radiological studies as well as serial tumor markers are consistent with disease-free survival after 39, 13, and 9 months. CONCLUSION: These results demonstrate the feasibility and safety of RFA for metastatic ovarian lesions to the liver in patients previously deemed as poor or non-surgical candidates, and suggest the potential for improvement in survival over unresected patients or in patients resected with residual disease.     

A case of retained placenta increta successfully treated via uterine arterial embolization using N-butyl 2-cyanoacrylate

A 29-year-old woman with placenta increta with hemorrhage underwent uterine artery embolization using 12.5% NBCA (N-butyl 2-cyanoacrylate) diluted with iodized oil (Lipiodol). Complete resolution of placenta increta without performing curettage was obtained. The uterus returned to its normal shape, with restored endometrium, junctional zone, and myometrium. Menstruation resumed after 3 months. In cases of retained placenta due to placenta accreta, and even those with placenta increta, uterine artery embolization using NBCA is a useful treatment.     

Dysmenorrhea

Dysmenorrhea affects over 50% of menstruating women and causes extensive personal and public health problems, a high degree of absenteeism and severe economic loss. In primary dysmenorrhea there is no macroscopically identifiable pelvic pathology, while in secondary dysmenorrhea gross pathology is present in the pelvic structures. With primary dysmenorrhea the pain is suprapubic and spasmodic, and associated symptoms may be present. Characteristically dysmenorrhea starts at or shortly after menarche. The pain lasts for 48-72 hours during the menstrual flow and is most severe during the first or second day of menstruation. It is now clear that in many women with primary dysmenorrhea the pathophysiology is due to increased and/or abnormal uterine activity because of the excessive production and release of uterine prostaglandins. Treatment with many of the prostaglandin synthetase inhibitors (nonsteroidal antiinflammatory drugs) will produce significant relief from dysmenorrhea and a concomitant decrease in menstrual fluid prostaglandins. For dysmenorrheic women who desire oral contraception, this agent will relieve the dysmenorrhea by suppressing endometrial growth, thus resulting in a decrease in the menstrual flow as well as in menstrual fluid prostaglandins. For those not requiring oral contraception the drug of choice for primary dysmenorrhea remains a prostaglandin inhibitor. Laparoscopy need be resorted to only if a pelvic abnormality is detected on examination or if treatment with prostaglandin inhibitors for up to six months is not significantly effective. In secondary dysmenorrhea, relief is obtained when the pelvic pathology--such as ovarian cysts, uterine fibroids, adhesions, cervical stenosis, congenital malformation of the uterus and endometriosis--is treated. In women using IUDs the dysmenorrhea is readily controlled with prostaglandin inhibitors since the underlying pathophysiology is excessive prostaglandin production and release.     

Selective vessel ligation in the pelvis: an invaluable tool in certain surgical procedures

While developing the technique of abdominal radical trachelectomy for conservative cervical cancer management, the vascular supply of the uterus was thoroughly examined. The question of how many vessels the uterus requires to ensure its viability arose. Following an abdominal radical trachelectomy for stage IB cervical carcinoma, blood supply of the body of the uterus is successfully maintained by only the two infundibulopelvic vessels (n= 34). Pregnancy has resulted following this technique (n= 2). Selective ligation of the pelvic vasculature has been utilized in the abdominal radical trachelectomy procedure. The objectives of this study were to investigate the vasculature of the infundibulopelvic and broad ligaments, to assess the contribution of the ovarian and uterine vessels to overall uterine perfusion, and to consider the clinical applications of selective pelvic vessel ligation. Ten fresh dissections of the infundibulopelvic vessels, broad ligaments of benign total abdominal hysterectomy, and bilateral salpingo-oophorectomy specimens were performed. Perfusion index (PI) and oxygen saturation (O(2)Sat) measurements using a modified probe were taken at specified intervals at the uterine cornu during ten routine benign abdominal hysterectomies to assess the contribution of the ovarian and uterine vessels to overall uterine perfusion and the concepts studied were utilized in certain gynecological procedures. The ovarian/infundibulopelvic vessels course medially through the broad ligament toward the uterine cornu and consistently give off a branch to the ovary on its lateral border. In addition, further vessels were noted to run laterally from the uterine cornu along the ovarian ligament to the medial aspect of the ovary. PI and O(2)Sat measurements imply that the uterine and ovarian vessels contribute almost equally to uterine perfusion. Clinical application by selective ligation of the pelvic vasculature has been utilized in certain gynecological procedures often prone to torrential life-threatening uterine hemorrhage. Selective temporary ligation of the uterine and ovarian vessels has proven useful in the surgical management of chemoresistant gestational trophoblastic disease, in the Strassman procedure, fertility-sparing surgery in ruptured cornual ectopic pregnancies, and unrelenting postpartum hemorrhage. Of the six supplying vessels (ovarian, uterine, and vaginal) to the uterus only two (ovarian or uterine or a combination thereof) are required for uterine viability.     

子宫神经去除术治疗子宫腺肌症疼痛的临床观察

目的探讨子宫神经去除术（LUNA）治疗子宫腺肌症痛经及慢性盆腔痛的临床效果。方法对患有痛经、非经期盆腔痛或性交痛的子宫腺肌症患者进行LUNA手术。采用视觉模拟评分法对痛经、非经期盆腔痛及性交痛量化评分。结果对60例子宫腺肌症患者术后随访6～24个月，其痛经、非经期盆腔痛或性交痛的症状均有明显改善，手术前后三者的评分变化差异均有显著性（P〈0．01），但术后各阶段之间的比较差异无显著性（P〉0．05）。患者满意率术后3个月为76．92％，术后24个月为69．23％。结论LUNA对缓解子宫腺肌症引起的痛经及慢性盆腔痛具有一定的疗效。     

Pathologic evaluation of uterine leiomyoma treated with radiofrequency ablation.

OBJECTIVE: To explore the mechanism by which radiofrequency ablation (RFA) treats uterine leiomyoma by observing the features of the lesions caused by RFA to leiomyoma tissue. METHODS: Specimens from treated lesions were observed after hysterectomy was performed immediately (acute test) or on the third day (chronic test) following treatment in 2 groups of 30 patients. Histopathologic studies were also performed for all specimens, with untreated specimens as controls. RESULTS: For the acute and chronic tests, specimens from the RFA-treated lesions included the center segment (group 1); the marginal segment (group 2); the segment 1-cm away from the margin (group 3); and the segment 2-cm away from the margin (group 4). In the acute test, group 1 showed a sharply demarcated area of coagulative necrosis that did not express estrogen receptor (ER) or progesterone receptor (PR); group 2 showed a severe hydropic degeneration or necrosis; and group 3 showed regular leiomyoma cells. The expression of ER and PR was significantly less in groups 2 and 3 than in the control group (P<0.05), but ER and PR expression in group 4, which had normal leiomyoma cells, was the same as in the control group (P>0.05). In the chronic test, group 1 showed carbonization and coagulation necrosis without ER or PR expression. There was severe hemorrhage and thrombosis in group 2; hyaline degeneration and tissue granulation in group 3; and mild degeneration in group 4. The expression of ER and PR was significantly lower in groups 2, 3, and 4 than in the control group (P<0.05). CONCLUSION: Radiofrequency ablation might treat uterine leiomyomas by inducing coagulative necrosis and depressing ER and PR expression.     

Laparoscopic Uterine Artery Occlusion Combined with Uterine-sparing Pelvic Plexus Block and Partial Adenomyomectomy for Adenomyosis: A Video Case Report

ObjectiveAdenomyosis usually causes dysmenorrhea and anemia. Clinically, it is difficult to be treated with medicine or by traditional surgery, however, hysterectomy is always performed for radical treatment. In this article, we introduce a new method that could control the dysmenorrhea and the anemia through laparoscopic uterine artery occlusion (LUAO) combined with uterine-sparing pelvic plexus block and partial adenomyomectomy for uterus preservation.DesignSurgical video article. Local institutional review board approval for the video reproduction was obtained.SettingA 42-year-old patient, who had a history of a previous cesarean delivery, was admitted to our department with complaints of progressive dysmenorrhea for more than 5 years and aggravated with anemia for 1 year. The patient had failed treatment with traditional Chinese medicine and gonadotropin-releasing hormone and had to take painkillers for nearly half a year. The patient had no desire for another pregnancy. After careful consideration, the patient strongly rejected hysterectomy and demanded the preservation of the uterus, insisting on the integrity of the organs. A gynecologic examination showed that the uterus was hard and enlarged similar to one that is more than 8 gestational weeks, without tender nodules in the rectouterine pouch. The visual analog scale pain score was 7, and her hemoglobin was 93 g/L (after correction). The preoperative magnetic resonance imaging implied that there was 1 lesion in the posterior wall and the maximum diameter of the lesion was 7.8 cm.InterventionsWe performed laparoscopic partial adenomyomectomy combined with occlusion of uterine artery to limit the amount of intraoperative bleeding, dissected the uterine branch of pelvic plexus nerve, and performed electrocoagulation blocking to relieve the dysmenorrhea. The specific operation procedures are as follows (Video):Firstly, we opened the peritoneum through Cheng's triangle, which contained the external iliac blood vessels, the round ligament, and the infundibulopelvic ligament (Fig. 1).Secondly, we separated the lateral rectal space and exposed the ureter, the internal iliac artery, the uterine artery, and the deep uterine vein.Thirdly, we found that the pelvic plexus was located on the outside of the sacral ligament and was approximately 2 to 3 cm below the ureter, going against the sacral ligament and passing through below the deep uterine vein (Supplemental Video 1).Fourthly, we separated the 4 layers of the paracervix [1]. The first layer included the internal iliac artery and the uterine artery. The second layer was the ureter. The third layer was the deep uterine vein. The last layer was the pelvic plexus, which involved the forward-going bladder branch, the inward-going uterine branch, and the downward-going rectal branch (Supplemental Video 2). These anatomic structures are similar to the complex architecture of an overpass called the Cheng's Cross [2] (Fig. 2).In this operation, only the uterine artery and the uterine branch would be blocked. Finally, we performed the partial adenomyomectomy. The endometrium, the myometrial tissues, and the serosa were repaired in some layers with continuous suture, depending on the depth of incision.The operation time was 92 minutes, and the intraoperative hemorrhage was approximately 50 mL. The patient was able to get out of bed on the first day after the operation and urinate after removing the catheter. On the second day after the surgery, the patient had exhaustion and defecation. From the third day after the surgery, gonadotropin-releasing hormone (Goserelin Acetate Sustained-Release Depot,3.6mg each, subcutaneous injection, name of the enterprise: AstraZeneca UK Limited) was used every 4 weeks, with a total of 3 times. Menstruation began on the 67th day after withdrawal of the drug. The results of postoperative condition of the patient followed up at 6 months after surgery were collected as follows: dysmenorrhea was significantly relieved (visual analog scale score was 2), hemoglobin was 123 g/L, and uterine volume was reduced to 43% of preoperative volume. The comparison of the patient's preoperative and postoperative magnetic resonance imaging showed that the uterus was approximately the same size as that of a woman of the same age, and the incision healed well (Fig. 3).ConclusionAdenomyosis is a common gynecologic disease, mainly occurring in women of childbearing age. Adenomyosis is defined as endometrial glands and stroma that invade the myometrium and is surrounded by chronical inflammation in the endometrium [3]. Secondary dysmenorrhea and menorrhagia are the most common chief complaints in patients with adenomyosis, among which dysmenorrhea is the most unbearable symptom [2]. In the past, we had always treated adenomyosis by hysterectomy [4]. With the continuous pursuit of quality of life, it is difficult to meet clinical needs through drugs and traditional surgical methods. Uterine sparing surgery is a current trend in the treatment of adenomyosis, which enables women to maintain fertility and avoid the effects of hysterectomy on sexual function and mental discomfort.Dysmenorrhea can be divided into peripheral dysmenorrhea and central dysmenorrhea. According to our previous studies on dysmenorrhea, the uterine branch nerve has a controlling effect on dysmenorrhea [2]. The purpose of pelvic plexus uterine branch ablation is to further relieve dysmenorrhea by blocking nerve conduction pathways. Therefore, we selectively blocked the uterine branch nerve to alleviate the dysmenorrhea of adenomyosis.The uterine artery controls 90% of uterine blood flow. According to our team research, LUAO is an effective method to treat symptomatic uterine myomas and adenomyosis. We investigated the morphologic change and apoptosis occurring in myomal and adjacent myometrial tissues after LUAO. We concluded that apoptosis through mitochondrial pathways may lead to reduction of the volume of myoma and myometrium and eventually relief of symptoms [5,6]. We speculated “single organ shock uterine” to explain uterine artery occlusion (UAO) mechanism, which was different from uterine artery embolization. The single organ shock theory of UAO can still inhibit the growth of myomas effectively. It is difficult to completely remove adenomyosis lesions during surgery, especially for diffuse adenomyosis. Therefore, in our team, we performed UAO combined with resection of focal lesions in key areas for patients with diffuse adenomyosis, instead of pursuing radical resection [7,8]. The purpose of UAO is to reduce the amount of bleeding during surgery and further atrophy of residual and scattered adenomyosis lesions in utero [5,6]. The intraoperative blocking of the uterine artery can reduce intraoperative bleeding and operation time, improve operation quality, and decrease recurrence rate.In our team, this technique has been used in clinic for more than 10 years. Our previous studies have shown that LUAO combined with pelvic plexus uterine branch nerve block and resection of most of the adenomyosis has achieved satisfactory clinical efficacy as a treatment for adenomyosis [2,3]. With this procedure, we can help patients with adenomyosis retain their uterus and relieve the anxiety caused by hysterectomy. In conclusion, UAO and uterine branch ablation in uterine sparing laparoscopic treatment is a safe and effective method, which may be considered as a good choice for symptomatic adenomyosis.