{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,11]],"date-time":"2026-06-11T06:01:10Z","timestamp":1781157670144,"version":"3.54.1"},"reference-count":27,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,6,11]],"date-time":"2026-06-11T00:00:00Z","timestamp":1781136000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Med."],"abstract":"<jats:sec>\n                    <jats:title>Background and objective<\/jats:title>\n                    <jats:p>Diagnosis and treatment strategies for adenomyosis are influenced by multiple factors, including patient preferences, adenomyosis subtype, and disease progression, with no standardized protocol currently established. In 2012, Kishi proposed four subtypes of adenomyosis based on magnetic resonance imaging (MRI) to guide clinical treatment. This study focuses on patients with severe adenomyosis who do not desire future fertility but wish to preserve their uterus. It investigates the clinical efficacy of subtotal adenomyotic lesion resection based on the Kishi classification, combined with sequential levonorgestrel-releasing intrauterine system (LNG-IUS) and gonadotropin-releasing hormone agonist (GnRH-a) therapy, in the management of severe adenomyosis, and evaluates the clinical outcomes and safety of this approach.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We used a descriptive case series design. A retrospective analysis was performed on 34 patients with severe adenomyosis who underwent this treatment protocol at the Department of Gynecology, the Changzhou Second People\u2019s Hospital Affiliated to Nanjing Medical University from December 2017 to October 2022. Clinical parameters, including hemoglobin concentrations, dysmenorrhea severity scores, and menstrual blood loss scores, before and after treatment, were observed and recorded.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      All 34 patients successfully underwent surgery. Comparisons of postoperative and preoperative values showed significant improvements in dysmenorrhea severity score, menstrual blood loss score, hemoglobin concentration, serum cancer antigen-125 (CA125) level, and uterine volume (all\n                      <jats:italic>p<\/jats:italic>\n                      \u202f&amp;lt;\u202f0.001). Only one patient experienced downward displacement of the intrauterine device, and a transvaginal ultrasonography revealed that the upper end of the device was approximately 1.5\u202fcm away from the uterine fundus. One patient exhibited a mild elevation in CA125, accompanied by an increase in dysmenorrhea severity score to 3 points, without a significant increase in menstrual blood loss being observed. No disease progression was noted in any patient.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>In patients with severe adenomyosis who do not desire future fertility, who have a strong preference for uterine preservation, and who have failed multiple conservative treatments, this combined regimen was associated with significant improvements in dysmenorrhea severity, menstrual blood loss, anemia, CA125 levels, and uterine volume over a 12-month observation period, without any serious adverse events. This finding suggests that the regimen may be a safe and effective treatment option. However, its exact efficacy still requires validation through prospective controlled studies.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fmed.2026.1831932","type":"journal-article","created":{"date-parts":[[2026,6,11]],"date-time":"2026-06-11T05:46:47Z","timestamp":1781156807000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Clinical efficacy and safety of subtotal resection of adenomyotic lesions based on the Kishi classification: a retrospective case series study"],"prefix":"10.3389","volume":"13","author":[{"given":"Zhenyue","family":"Qin","sequence":"first","affiliation":[{"name":"Shaoxing Maternity and Child Health Care Hospital, Shaoxing University","place":["Shaoxing, China"]},{"name":"Maternity and Child Health Care Affiliated Hospital, Shaoxing University","place":["Shaoxing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dan","family":"Song","sequence":"additional","affiliation":[{"name":"Shaoxing Maternity and Child Health Care Hospital, Shaoxing University","place":["Shaoxing, China"]},{"name":"Maternity and Child Health Care Affiliated Hospital, Shaoxing University","place":["Shaoxing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zhiyong","family":"Dong","sequence":"additional","affiliation":[{"name":"The Second Affiliated Hospital of Chongqing Medical University","place":["Chongqing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bingying","family":"Lu","sequence":"additional","affiliation":[{"name":"The Third Affiliated Hospital of Nanjing Medical University (The Second People\u2019s Hospital of Changzhou)","place":["Changzhou, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Weiwei","family":"Wei","sequence":"additional","affiliation":[{"name":"The Third Affiliated Hospital of Nanjing Medical University (The Second People\u2019s Hospital of Changzhou)","place":["Changzhou, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jiming","family":"Chen","sequence":"additional","affiliation":[{"name":"The Third Affiliated Hospital of Nanjing Medical University (The Second People\u2019s Hospital of Changzhou)","place":["Changzhou, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,6,11]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"177","DOI":"10.1001\/jama.2020.26436","article-title":"Diagnosis, evaluation, and treatment of Adenomyosis","volume":"326","author":"Kho","year":"2021","journal-title":"JAMA"},{"key":"ref2","doi-asserted-by":"publisher","first-page":"431","DOI":"10.1186\/s12905-021-01577-x","article-title":"Characterization of patients that can continue conservative treatment for adenomyosis","volume":"21","author":"Miyagawa","year":"2021","journal-title":"BMC Womens Health"},{"key":"ref3","doi-asserted-by":"publisher","first-page":"3432","DOI":"10.1093\/humrep\/des332","article-title":"How common is adenomyosis? 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