Weekly Surgery | Professor Wu Ruifang: Uterine Reconstruction for Fertility Preservation in Diffuse Adenomyosis

Case History

A 33-year-old patient complained of progressive dysmenorrhea for 4 years (VAS score 9), requiring analgesics during menstruation.

She had previously received LNG-IUS (Mirena) and GnRHa treatment with poor efficacy, complicated by secondary infertility and a desire for fertility.

Ultrasound showed an enlarged uterus (92mm103mm80mm), heterogeneous myometrial echo, multiple small cystic areas, and subendometrial hyperechoic cords extending radially into the myometrium.

MRI revealed an enlarged uterus (109mm95mm108mm), diffuse thickening of the myometrium with mixed signal intensity, multiple punctate short T1 and long T2 signals, and thickened junctional zone (JZ) (anterior wall 16mm, posterior wall 28mm), consistent with imaging features of adenomyosis.

Follow-up

Six months postoperatively, sonohysterography showed a normal-sized uterus with a defect area at the fundus: 19mm18mm10mm. Twelve months postoperatively, sonohysterography showed a normal-sized uterus with good myometrial filling and no filling defects.

No adjuvant therapy for adenomyosis was administered after surgery, and the patient was followed up regularly.

Serum CA125: 175.1 IU/mL preoperatively, decreased to normal level (15.1 IU/mL) postoperatively.

The last follow-up at the end of March 2026 (16 months postoperatively) showed regular menstrual cycles, moderate menstrual flow, no dysmenorrhea, and the patient was in natural pregnancy preparation.

Surgeon Introduction

Wu Ruifang

Chief Physician, Peking University Shenzhen Hospital; Professor and PhD Supervisor, Peking University

Winner of the Wu Jieping Medical Research Award, Chinese Physician Award, and Contribution Award for the Development of Public Health and Preventive Medicine
Director of the National Demonstration Base for Early Diagnosis and Treatment of Cervical Cancer
Director of the Institute of Obstetrics and Gynecology, Peking University Shenzhen-Hong Kong University of Science and Technology Medical Center
Chairman of the First Committee of Fertility Protection Branch, Chinese Preventive Medicine Association
Vice Chairman of the Obstetrics and Gynecology Committee, Chinese Medical Women's Association
Member of the Gynecological Endocrinology Group, Society of Obstetrics and Gynecology, Chinese Medical Association
Editorial Board Member of Chinese Journal of Obstetrics and Gynecology and other journals
Editor-in-chief of 3 monographs, translator of 2 monographs, contributor to many books and textbooks, published more than 300 academic papers, and her research achievements won 12 provincial and ministerial science and technology awards.

Zeng Liping

Chief Physician, Master of Medicine, Expert of Obstetrics and Gynecology Center, Peking University Shenzhen Hospital

Standing Member of the Fertility Protection Branch, Chinese Preventive Medicine Association
Vice Chairman of the Family Planning Branch, Shenzhen Medical Association
Deputy Leader of the Female Fertility Protection Group, Maternal and Child Health Industry Branch, National Health Industry Enterprise Management Association
Member of the First Council of Obstetrics and Gynecology Branch, Shenzhen Medical Doctor Association
Undertaken and participated in more than 10 projects supported by the National Natural Science Foundation of China and provincial/municipal funds, published more than 50 medical research papers (12 included in SCI), and edited/co-edited 4 academic works.

Editor: Qing Huan

Reviewer: Ma Ye