*2.2.2.2 Contraindications*

The contraindications were as follows: (i) Nulliparous; (ii) Complications due to other pelvic diseases; (iii) Acute appendicitis, acute pelvic inflammatory disease; (iv) Deep endometriosis; (v) Allergic to alcohol or iohexol.

### *2.2.3 Operating process of SHPB*

The patient was asked to lie on the CT table with a suitable pillow under the abdomen. After confirming the absence of any contraindications to a neural block, an intravenous infusion channel was opened. CT scans are used to confirm the location of the L5 and S1 intervertebral spaces, which are the target regions for puncture. Then, the coronal CT scan is obtained by taking the puncture space as the midline, including the upper, lower and central sections with a thickness of 3 mm. Select the best puncture section from CT images and plan the puncture path. The anterolateral margin of the lumbar 5 was the left margin and the anterior margin of the psoas major was the right margin. After planning the puncture route and bilateral puncture points, the angle and depth of puncture points were measured with CT ruler. According to the

#### **Figure 1.**

*The upper and lower abdominal nerve block was performed by puncture and injection (Three-dimensional reconstruction by CT).*

measurement results, place the puncture needle to the target (**Figure 1**). A solution of 2% lidocaine containing iohexol (a contrast agent) was injected, and its distribution was observed on a CT rescan. An injection site is determined as appropriate if: (i) the lidocaine-iohexol solution is distributed along the anteromedial margin of the psoas major muscle and the anterior vertebral body (**Figure 2**) and (ii) a loss of sensation bilaterally in the lower limbs without dyskinesia is observed after 15 min. With the injection site confirmed, a contrast medium of dehydrated alcohol solution (4 mL) containing 3% iohexol (0.5 mL) is injected bilaterally to achieve a neurolytic block of the superior hypogastric plexus. This is followed by repeated CT, and three-dimensional

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*Interventional Treatment of Endometriosis DOI: http://dx.doi.org/10.5772/intechopen.93054*

recorded.

reconstruction to observe the distribution of the dehydrated rate, blood pressure. At the same time blood oxygen saturation level is recorded. Any complications are also

At present, there is no reliable follow-up data of big data, but according to the existing experience, the effective rate is 70%, the duration is 1–3 years, and there is no serious complications related to nerve block. Sacral neurotomy as the predecessor of nerve block treatment appeared 20 years ago, but the technology of nerve block by drugs is still very young. The improvement methods can be as follows: to study the characteristics and efficacy of different nerve blockers, to improve the puncture approach and the position of the blocking point, etc. [15]. SHPB is a new way of treatment. There are no data about future fertility. The upper and lower abdominal nerves are the proximal part of sacral nerves. The same reason is that there are few data at present, which cannot explain the effect of nerve block on

Ultrasound-guided puncture sclerotherapy [16], sclerosing agent selection includes anhydrous ethanol, lauryl alcohol, etc. Anhydrous ethanol is less used due to easy to cause low fever, sharp pain, allergies and drunk-like reactions and other adverse reactions poly(lauryl alcohol), the scientific name of polyoxyethylene lauryl alcohol ether, is called polydocanol in Europe. After the injection into the cyst, the protein of the cell will be precipitated quickly, the double molecular layer of the cell wall will be destroyed, the epithelial cells of the cyst wall will be necrotic, the secretion of the fluid of the cell will be inhibited, and the aseptic inflammation will be produced to make the fibrosis of the cyst wall, so as to achieve the purpose of curing the cyst. The drug is widely used. Before the operation, the number and nature of the cyst were confirmed. Under the guidance of real-time ultrasound positioning, the puncture needle entered the center of the cyst, extracted the fluid from the cyst, rinsed the wall of the cyst repeatedly with normal saline, and finally injected with poly(lauryl alcohol) for retention, with a total volume of <50 ml. The results showed that the total effective rate of ultrasound inter-

*2.2.4 Follow-up time and efficacy evaluation after SHPB treatment*

fertility, sexual function and urination function.

*2.3.1 Pelvic endometriosis*

*2.3.2 Adenomyosis*

**3. Conclusions**

**2.3 Ultrasound interventional therapy for endometriosis**

vention was 93.75%, which had little effect on ovarian reserve function.

were relieved, and the treatment process was safe.

High intensity (frequency < 1 MHz) focused ultrasound can be used to treat adenomyosis [17]. High intensity focused ultrasound (HIFU) can promote lowfrequency and high-energy ultrasound to reach the target tissue through the body surface fat. It makes use of the cavitation, mechanical and thermal effects of ultrasound to induce irreversible damage and degeneration of adenomyosis cells. After the operation, the volume of the lesion was reduced, the symptoms of the patients

The symptoms of endometriosis and adenomyosis are different from each other; so, individualized treatment according to different needs of patients is of great significance.

#### **Figure 2.**

*Upper and lower abdominal nerve block by puncture injection.*

*Endometriosis*

**Figure 1.**

*reconstruction by CT).*

measurement results, place the puncture needle to the target (**Figure 1**). A solution of 2% lidocaine containing iohexol (a contrast agent) was injected, and its distribution was observed on a CT rescan. An injection site is determined as appropriate if: (i) the lidocaine-iohexol solution is distributed along the anteromedial margin of the psoas major muscle and the anterior vertebral body (**Figure 2**) and (ii) a loss of sensation bilaterally in the lower limbs without dyskinesia is observed after 15 min. With the injection site confirmed, a contrast medium of dehydrated alcohol solution (4 mL) containing 3% iohexol (0.5 mL) is injected bilaterally to achieve a neurolytic block of the superior hypogastric plexus. This is followed by repeated CT, and three-dimensional

*The upper and lower abdominal nerve block was performed by puncture and injection (Three-dimensional* 

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**Figure 2.**

*Upper and lower abdominal nerve block by puncture injection.*

reconstruction to observe the distribution of the dehydrated rate, blood pressure. At the same time blood oxygen saturation level is recorded. Any complications are also recorded.
