The Application of Uterine Artery Occlusion Combined with Uterine-Vaginal Nerve Block Technique in Patients with Adenomyosis.

Adenomyosis is a commom gynecological disease, which affects women from 30 to 50 years old with the symptoms of dysmenorrhea or menorrhagia. In the past, we always use hysterectomy to treat patients even young women, but now after years of clinical research,we found that the technique of laparoscopic uterine artery occlusion (LUAO) combined with uterine-vaginal nerve blockade would have a good near- and long-term effects on patients with adenomyosis who wish to preserve the uterus. Copyright:

Adenomyosis is a diffuse or nodular lesion of myometrium characterized by ectopic endometrial glands and stroma within the myometrium. It usually affects women from 30 to 50 years old, mainly with symptoms of dysmenorrhea and menorrhagia, seriously affecting women's quality of life.[1] In the past, hysterectomy was almost the only way to treat patients with adenomyosis, even for young patients who wish to preserve the uterus. After years of clinical research, Prof. Cheng, who is from Shanghai Tenth People's Hospital, found that the technique of laparoscopic uterine artery occlusion (LUAO) combined with uterine–vaginal nerve blockade has good near- and long-term effects on patients with adenomyosis who wish to preserve the uterus [Figure 1].

Figure 1

The photo of uterine artery occlusion combined with uterine-vaginal nerve block technique, captions in the picture: (1) Internal iliac artery, (2) uterine artery, (3) ureter, (4) deep uterine vein, (5) hypogastric nerve, (6) S2-4 pelvic splanchnic nerve, (7) bladder branch, (8) uterine–vaginal branch, (9) uterosacral ligament

LUAO can cause the necrosis of adenomyosis lesion and relieve the symptoms. According to the experiment by Chen et al., this type of operation has achieved good outcome in the clinical treatment of adenomyosis in recent years.[2] As shown in Figure 1(2), when uterine arteries are occluded, the uterine blood flow is reduced by 90%, which causes transient uterus ischemia. Different pathophysiologic changes occur in small vessels of normal myometrium and that of adenomyosis. About 6–9 h after uterine artery block, while collateral vessels from the ovarian artery, vaginal artery, and pelvic small vessels can be used for reconstruction, the clot was lysed in the vessels of myometrium, but not in the vessels of the adenomyosis, which resulted in the recovery of myometrium, but not necrosis of adenomyosis. At the same time, the necrosis of ectopic endometrial can reduce the secretion of prostaglandins, which can relieve the dysmenorrhea and menorrhagia.

At the level of S3, the sympathetic nerves of T12 and L1-2 and the parasympathetic nerves of S2–S4 form the pelvic plexus, which go through the outside of the uterosacral ligaments, where the nerve fiber bundles cross, which was called “Cheng's cross.”[3] “Cheng's cross” includes the bladder branch, uterine vaginal branch, and rectal branch. As shown in Figure 1(7), the bladder branch that moves forward toward the bladder mainly dominates the detrusor of the bladder, causing urination; As shown in Figure 1(8), the uterine vaginal branch that moves obliquely toward the cervix mainly dominates the contraction of the uterus, which can cause dysmenorrhea and has almost no effect on the detrusor of the bladder. Fifty-two patients with adenomyosis were offered to undergo laparoscopic excision of partial adenomyosis, uterine artery occlusion, and uterine branch of pelvic plexus block from January 2009 to December 2013. All patients were asked to return to the hospital for follow-up examinations. Dysmenorrhea pain was divided into four grades based on visual analog scale (VAS) scores: no dysmenorrhea (0), mild dysmenorrhea (1–3), moderate dysmenorrhea (4–6), and severe dysmenorrhea (7–10). At 36 months after operation, VAS dysmenorrhea scores were significantly lower than the preoperative scores (2.6 ± 0.9 vs. 8.3 ± 1.2, P < 0.01), the patient's dysmenorrhea symptom relief rate reached 100%, and no case of dysuria.[4]

Ethical statement

This study was approved by the IRB of Shanghai Tenth People's Hospital (IRB No. SHSY-IEC-4.1/19-29/03 obtained on August 21th, 2019) with the need of obtaining written consents from the study participates.

Financial support and sponsorship

This project was supported by the National Natural Science Foundation of China (No. 81602260).

Conflicts of interest

There are no conflicts of interest.