34-year-old Ms. Fan has been married for many years, and having a baby as soon as possible is the couple's common wish. Two years ago, she was diagnosed with adenomyosis with intrauterine adhesions due to menstrual irregularities. Recently, Ms. Fan's dysmenorrhea and anemia became more and more serious, and she traveled thousands of miles to Changsha Jiangwan Hospital, where the hysteroscopic minimally invasive clinical medical technology demonstration base of Hunan Province is located, hoping to bid farewell to the pain and usher in a good pregnancy through the treatment of traditional Chinese and Western medicine "palace protection".
What is adenomyosis?
Three major manifestations: dysmenorrhea, heavy menstrual bleeding, infertility
Zhou Jing, deputy director of technology and director of gynecology of Jiangwan Hospital, introduced that adenomyosis tends to occur in women of childbearing age, and in the past there was a name, called "intrinsic endometriosis", which refers to the restless endometrium breaking through the basal layer, invading the myometrium to grow, and over time, adenomyosis was formed.
When women menstruate, the endometrium in the normal position will shed and bleed, and can be smoothly excreted through the cervix and vagina, so there is no big problem; However, the endometrial tissues that grow into the myometrium of the uterus in ectopic are not so well-behaved, they have no outlet to drain and unclog up, and can only accumulate in the myometrium, resulting in prolonged menstrual periods, increased menstrual flow, dysmenorrhea anemia, enlarged uterus, etc., which have a serious impact on physical and mental health.
Not only that, adenomyosis is also closely related to infertility, which may not only interfere with normal embryo implantation, but also lead to abnormal embryo implantation and early and late miscarriage and difficult labor.
Why is adenomyosis difficult to treat and prone to recurrence?
Lesions are invasive and recurrent and require caution
Due to the characteristics of scattered lesions and continuous invasion of the myometrium, adenomyosis is difficult to make it disappear by taking medicine alone, and the symptoms are easy to recur after stopping the drug, and long-term management is required. Older or non-childbearing patients tend to opt for hysterectomy or conservative surgery.
However, for young patients who need to preserve fertility, adenomyosis is very easy to cause infertility or miscarriage, if you want to get pregnant smoothly, you need to do "uterine protection" surgery first to solve intrauterine lesions, intrauterine adhesions, endometrial polyps, etc., and restore the normal uterine cavity environment. Especially for patients with adenomyosis complicated with intrauterine adhesions, many hospitals adopt hormone growth intima after surgery, and comprehensive diagnosis and treatment plans are particularly important for such patients.
Changsha Jiangwan Hospital, as a tertiary reproductive obstetrics and gynecology specialist hospital and a provincial hysteroscopic demonstration base, has a more standardized control over the treatment of such surgeries, and uses the combination of traditional Chinese and Western medicine to strive for better treatment results for patients, which has been unanimously praised and recognized by patients.
What should I do if I want to "protect the uterus" to prevent recurrence?
Multidisciplinary joint diagnosis of integrated traditional Chinese and Western medicine, one-stop help pregnancy
Jiangwan experts often remind patients with adenomyosis who have fertility needs: early treatment, early pregnancy!
As the patient's illness increases, the condition will become more and more serious, the symptoms will become more and more obvious, the intrauterine environment will deteriorate, and the possibility of successful pregnancy will gradually decrease. Patients should work with their doctor as early as possible to find other treatment options such as multiple medications, surgeries, assisted reproductive technologies, etc. until childbearing is complete. The principle of treatment and the primary purpose of surgery is to create favorable conditions for pregnancy, solve intrauterine diseases, relieve symptoms while retaining the original endocrine function, reducing the risk of recurrence, and improving the pregnancy rate.
1. Four-dimensional ultrasonic classification evaluation
The diagnosis of adenomyosis is mainly based on clinical symptoms, gynecological examination and imaging examination. In the process of clinical diagnosis and treatment, the doctor first makes a basic judgment by asking about the history in detail, combined with the typical manifestations of adenomyosis, and secondly, with ultrasound imaging and grading examination, Jiangwan Hospital four-dimensional color ultrasound has the advantages of clear vision, convenient and fast, non-invasive and accurate, and strong operability, which provides important guidance for the patient's subsequent treatment. In addition, serum CA125 and measurement of inflammatory indicators can also help to confirm the diagnosis of adenomyosis.
2. Preoperative Chinese and Western drug pretreatment:
In Changsha Jiangwan Hospital, the doctor will evaluate the infertility or fertility of adenomyosis patients who visit for the first time, understand the status of their uterus, pre-treat with Chinese medicine before surgery, improve dysmenorrhea and the internal environment of uterus and pelvis, make adenomyosis lesions atrophy, and it is easier to treat intrauterine diseases in the next operation, reduce intraoperative bleeding, and help improve the intrauterine environment.
3. Combined treatment of traditional Chinese and Western medicine to protect fertility:
For patients with fertility needs, the Jiangwan gynecology team protects the patient's endometrium as much as possible, and for larger uterine adenomyomas, the first drug treatment is adopted, and then minimally invasive Haifu treatment is adopted, using the principle of ultrasound focusing and tissue penetration to make the lesion coagulate necrosis, preserve the uterus, and preserve fertility. For patients with adenomyosis complicated with endometrial polyps, intrauterine adhesions, severe hydrosalpinx and other diseases, the Jiangwan gynecology team performed hysteroscopic combined diagnosis and treatment, which solved a variety of problems at one time, reduced the recurrence rate of surgery, and solved the problems that have puzzled the industry for many years.
After the operation, the chief physician Liu Xingdong led the high-titled, high-educated Chinese medicine team, combining disease differentiation and differentiation, symptomatic through drugs to eliminate tiny ectopic lesions, make rapid apoptosis, and regulate the patient's hormone levels to avoid the recurrence of adenomyosis. The combination of Chinese and Western medicine, acupuncture and medicine, timely and rapid recovery of ovarian function, help patients get pregnant quickly. Pregnancy can further inhibit the growth of the endometrium.
4. Multidisciplinary joint management of fertility and fetal protection:
After adenomyosis lesion resection surgery, the Gynecology, Obstetrics, Chinese Medicine and Reproductive Medicine Center of Jiangwan Hospital will carry out multidisciplinary experts to assist in pregnancy, Chinese medicine to help improve dysmenorrhea, progesterone treatment side effects, and help patients choose the right time for pregnancy.
Patients with adenomyosis should be managed as a high-risk pregnancy after pregnancy, with particular attention to intrauterine growth of the fetus. In patients with adenomyosis who become pregnant after conservative surgery, in addition to the above measures, special attention needs to be paid to the monitoring and management of uterine incision scars to avoid uterine rupture during pregnancy.
5. Obstetrics focuses on safe delivery:
The mode of delivery in patients with adenomyosis should be determined according to obstetric indications. In general, patients with external focal lesions and small lesions after adenomyosis can have a vaginal trial of labor under close supervision after pregnancy.
Patients with intrinsic diffuse lesions and severe adenomyosis postoperative pregnancy (especially after assisted reproductive technology therapy) need to consider cesarean section to end labor. Pregnant patients with adenomyosis may develop complications during pregnancy (eg, placenta implantation), so comprehensive management during childbirth requires intensive management.
In Jiangwan Hospital, Ms. Fan improved the state of the uterus and the pelvic environment through the pretreatment of traditional Chinese and Western medicine drugs in the early stage, and further evaluated fertility through hysteroscopic combined surgery to treat adenomyosis, combined with postoperative multidisciplinary consultation to consolidate the curative effect, and at the same time cooperate with the ovulation induction and pregnancy assistance of reproductive medicine experts, and has successfully preserved the fetus in Jiangwan Hospital and successfully delivered a lovely baby!
Treatment of adenomyosis is a long-term management, and the timing and modality of treatment is particularly important. Jiangwan Hospital has always adhered to the multidisciplinary joint diagnosis and treatment of traditional Chinese and Western medicine, and the expert team of Zhenggao is hands-on, different from the traditional therapy simple "everything is done", to preserve the complete shape of the uterus as much as possible for patients, improve dysmenorrhea, reduce menstrual flow and other symptoms, and improve the probability of successful pregnancy and delivery. Minimally invasive "palace protection" treatment of adenomyosis has become a banner of Changsha Jiangwan Hospital, attracting patients from all over the country and even overseas to seek medical treatment.
"From the perspective of humanization of medical services, we fully understand the strong willingness of patients to preserve uterus and fertility, and treat every treatment with caution." Director Zhou Jing and Director Liu Xingdong said when consulting patients that this is not only the wish of Jiangwan's multidisciplinary expert team, but also represents the voice of every Jiangwan medical staff. "We will live up to the trust of patients and do our best to continue to protect women's reproductive health and fertility!" (Correspondent He is Zhao Lei)