子宫腺肌症318例诊治分析

Diagnosis and treatment of uterine adenomyosis: an analysis of 318 cases

目的 分析近年来子宫腺肌症的发病情况、临床表现、诊断和治疗。方法 回顾性分析1997年1月～1999年12月本院收治的318例子宫腺肌症患者的临床资料。结果 318例子宫腺肌症占我院同期妇科住院人数的5.7％、妇科手术子宫切除的20.9％。术前痛经者217例(68.2％),月经过多者132例(41.5％);术前诊断为子宫腺肌症192例,诊断符合率为60.4％,B超诊断符合率为60.5％,血CA125测定阳性率为72.3％。除2例行腺肌瘤剔除术外,全部患者均行子宫切除术,其中33例术前曾使用内美通、丹那唑、米非司酮、雌孕激素类及雄激素等治疗达3个月以上,80.0％痛经明显缓解,但75.0％患者停药后第1个月经周期痛经即复发。结论子宫腺肌症目前仍以手术治疗为主,治疗子宫内膜异位症的常用药物对子宫腺肌症痛经均有效,但停药后腺肌症患者痛经易复发。

Objective To investigate the incidence, clinical characteristics, diagnosis and treatment of uterine ade-nomyosis.Methods Clinical data of 318 patients with adenomyosis confirmed by pathology from January 1997 to December 1999 admitted in our gynecological ward were analyzed retrospectively. Results The incidence of adenomyosis was 5.7% of total gynecological hospitalized patients and accounted for 20.9% among all patients hysterectomy.217/318 (68.2%) cases had dysmenor-rhea and 132 (41.5%) had menorrhagia.A hundred and ninety-two cases were diagnosed as adenomyosis preoperatively, with 60.4% diagnostic accuracy. The serum CA-125 was positive in 72.3% of patients measured. All except two patients were treated with hysterectomy. Before operation, 33 patients had received hormone treatment, e.g.gestrinone, danazol, mifepristone, estrogen, progestins or androgen, for more than three months.Dysmenorrhea was relieved in 80.0% of patients during the hormone medicine treatment, but symptoms recurred in 75.0% of cases at the first menstrual cycle after the cessation of treatment. Conclusions Hysterectomy remains the dominant treatment of adenomyosis up to now. Drugs effective for treatment of endometriosis were also effective for relief of dysmenorrhea to patients with uterine adenomyosis although the dysmenorrhea recurred rapidly when medical treatment was stopped.