绝经后子宫内膜异位症22例临床分析

Clinically Characteristic Analysis of 22 Patients with Postmenopausal Endometriosis

目的 :探讨绝经后子宫内膜异位症 (内异症 )的临床特点。方法 :回顾性分析我院自1993年 6月至 2 0 0 2年 6月手术证实的 2 2例绝经后内异症患者的临床资料。结果 :患者年龄 4 7～ 6 5岁 ,平均 5 5 .6± 4 .8岁。主要症状有盆腔包块 15例 ,绝经后阴道流血 9例 ,阴道分泌物增多2例 ,慢性盆腔疼痛 1例。 19例 (86 .4 % )术前误诊。 2 2例均行全子宫加双附件切除术。I、II期 3例 ,III、IV期 19例。术后病理证实合并子宫肌瘤 13例 ,子宫腺肌病 7例 ,子宫内膜癌 2例 ,卵巢癌 1例。随诊时间超过 6个月的有 12例 ,其中HRT者 7例均无复发。结论 :绝经后内异症很可能是绝经前就存在的。临床表现不典型 ,常常与其他激素依赖性疾病同时存在 ,易于漏诊。全子宫加双附件切除术是诊断及治疗的主要方法。

Objective:To describe the clinical feature of postmenopausal endometriosis.Methods:From June 1993 to June 2002,there were 22 patients of postmenopausal endometriosis treated with surgery in our hospital.Clinical data were analyzed retrospectively.Results:The average age was 55.6±4.8 years old.The average period of menopause was 5.6±3.7 years.8 patients had the history of dysmenorrhea,with 3 patients diagnosed of endometriosis before,one patient had received hormonal replacement therapy (HRT) for 5 years.Chief complaint included 15 cases of pelvic mass,9 cases of postmenopausal vaginal bleeding,2 cases of increased discharge and one chronic pelvic pain.Endometriosis were not preoperatively considered in 19 cases.All patients underwent total hysterectomy and bilateral salpingo-oophorectomy.Stages of rAFS were 3 cases of stage I and II,19 cases of stage III and IV.The final pathologic findings of 22 cases were endometriosis with leiomyoma in 13 cases,adenomyosis in 7,endometrial carcinoma in 2 and ovarian cancer in 1.12 patients had followed up for more than 6 months,and 7 of them received HRT without evidence of recurrence.Conclusions:Postmenopausal endometriosis was most likely the persistence of premenopausal endometriosis.Because its clinical picture was atypical and it was often consistent with other hormone-dependent diseases,it was often misdiagnosed.Total hysterectomy and bilateral salpingo-oophorectomy was the critical methods for diagnosis and treatment.Postoperative HRT seemed not to result in relapse.