Nihon University School of Medicine, Obstetrics and Gynaecology, Tokyo 101-8309, Japan.
Reprod Biomed Online. 2011 Jan;22(1):94-9. doi: 10.1016/j.rbmo.2010.09.014. Epub 2010 Nov 30.
The treatment for severe adenomyosis has usually been hysterectomy, because there is no line of demarcation between diseased and normal tissue. Yet many such women wish to retain their uterus and some even wish to bear children. This report evaluates the efficacy of a new method of adenomyomectomy, where adenomyotic tissues are radically excised and the uterine wall is reconstructed by a triple-flap method, without overlapping suture lines, to prevent uterine rupture in subsequent pregnancies. This is a prospective case series followed for 10 years from June 1998 to August 2008 of 104 women with severe adenomyosis verified histologically and with magnetic resonance imaging. There was a dramatic reduction in both dysmenorrhoea and hypermenorrhoea and all patients returned to having normal menstrual cycles. Of 26 women who wished to conceive, 16 became pregnant, 14 (53.8%)went to term and delivered a healthy baby and there were no cases of uterine rupture. Adenomyosis symptoms recurred in only four out of 104 cases. The procedure thus resulted in a dramatic reduction in symptoms and allowed over half of women who wished to conceive to go to term without uterine rupture.
严重子宫腺肌病的治疗方法通常是子宫切除术，因为病变组织和正常组织之间没有明确的界限。然而，许多这样的女性希望保留子宫，甚至有些希望生育孩子。本报告评估了一种新的腺肌病切除术的疗效，该方法通过三重瓣法彻底切除腺肌组织，并重建子宫壁，避免重叠缝线，以防止后续妊娠时子宫破裂。这是一项前瞻性病例系列研究，从 1998 年 6 月至 2008 年 8 月，对 104 例经组织学和磁共振成像证实的严重子宫腺肌病患者进行了 10 年的随访。痛经和月经过多的症状明显减轻，所有患者的月经周期均恢复正常。在 26 名希望怀孕的患者中，16 人怀孕，14 人（53.8%）足月分娩健康婴儿，无一例子宫破裂。104 例中有 4 例仅出现腺肌病症状复发。因此，该手术显著减轻了症状，使半数以上希望怀孕的患者能够足月妊娠而不发生子宫破裂。
