*2.1.6.2 Postoperative complications*


### *2.1.7 Follow-up time and efficacy evaluation after UAE treatment*

## *2.1.7.1 Follow-up time*

After UAE treatment, reexamination assessment is required at 1, 3, and 6 months, and once a year thereafter. The contents of follow-up included change of lesion size, menstruation, sex hormone level, change of dysmenorrhea degree, and CA125 level in patients with adenomyosis.

**111**

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

A large number of clinical trial data [11, 12] showed that 97–100% of patients could tolerate and complete the operation, 77–97.4% of patients had improvement of dysmenorrhea symptoms, and amenorrhea happens occasionally. About 20% of patients need operation or second UAE because of unsatisfactory effect or recurrence of symptoms.

The superior hypogastric plexus consists of the lumbar splanchnic nerves (from the L3–L4 sympathetic ganglia) and the abdominal aortic plexus, which distributes its fibers to the anterior sacral promontory of the L5 vertebral body below the iliac bifurcation of the abdominal aorta [13]. The superior and inferior ventral nerve block was derived from the sacral neurotomy 20 years ago. Under the guidance of CT, the puncture needle was placed around the superior and inferior ventral nerve in front of the cone, and anhydrous alcohol or other nerve blockers were used to block the nerve so that local pain cannot be transmitted back to the brain through

(i) An ultrasonogram indicated uterine adenomyosis, with a slight increase of the cancer antigen (CA)-125 or (ii) there was a history of relevant endometriosis operation along with the absence of surgical indications for immediate reoperation. Patients who satisfied either criterion were then included if they met all the following additional criteria: (iii) periodic hypogastric pain during menstruation, with a visual analog scale (VAS) score >6 (severe); (iv) age >40 years; (v) absence of menorrhagia and significant pelvic mass; and (vi) absence of dysmenorrhea due to intrauterine devices. Among the patients who satisfied these criteria, we enrolled

The contraindications were as follows: (i) Nulliparous; (ii) Complications due to other pelvic diseases; (iii) Acute appendicitis, acute pelvic inflammatory disease;

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

those who provided written informed consent to undergo an operation.

(iv) Deep endometriosis; (v) Allergic to alcohol or iohexol.

**2.2 Nerve intervention: The superior hypogastric plexus block**

*2.2.1 Rationale for SHPB in uterine adenomyosis*

the nerve, to achieve the purpose of analgesia [14].

*2.2.2 Indications and contraindications of SHPB*

*2.2.2.1 Indications*

*2.2.2.2 Contraindications*

*2.2.3 Operating process of SHPB*

*2.1.7.2 Clinical efficacy evaluation*
