子宫腺肌病436例临床分析

Clinical analysis of 436 cases of uterine adenomyosis

目的：探讨子宫腺肌病的发病因素及诊治方法，旨在提高临床诊断准确率。方法：对1999年1月至2004年12月间在吉林大学第二医院妇科住院经手术及病理证实为子宫腺肌病的436例患者的临床资料进行回顾性分析。结果：子宫腺肌病例的发病率为13．7％（436／3182），其中81．0％在36—50岁之间．有妊娠史、分娩史，官腔操作史分别为96．8％、94．7％、73．6％。有继发性痛经、月经异常的分别为72．2％、60．6％。子宫增大占94．0％，宫体压痛占34．4％。超声诊断符合率78．3％。术前诊断符合率81．7％，子宫次全切除术占54．6％；子宫全切术占43．3％。结论：子宫腺肌病是妇科常见的良性疾病之一，漏误诊率较高，因此术前诊断需结合病史、临床症状、妇科检查和超声等指标，进行综合分析、鉴别，降低术前误诊、漏诊率。

Objective： Etiopathogenesis and the methods of diagnosis and treatment have been discussed, in order to raise the diagnosis accuracy. Methods： Clinical data of 436 patients who had done surgery and proved to be adenomyosis by pathology in these six years were retrospect＇rvely analyzed. Results- The incidence of uterine adenomyosis was 13.7% （436/3182）. 81.0% of cases is between 36 and 50y.96.8% of these patients have the history of pregnancy and 94. 7% has the history of delivery. Clinical diagnostic symptoms were dysmenorrhoc （64.4% ）, abnormal menstruation （60.6%）. Augmentation of uterine was 94. 0 % and tenderness was 34.4% in gynecologial examination. Coincidence rate between pathology and sonography is 78.3 %. Coincidence rate between pathology and preoperative diagnosis is 81.7%. Optimal treatment was hysterectomy, 54.6% is subtotal hysterectomy,43.3% is total hysterectomy. Conclusion： Adenomyosis is one of the most common gynecological benign diseases. It is often complicated with leiomyoma and/or chocolate cyst of ovary; so we must distinguish carefully and depress the rate of misdiagnosis and missed diagnosis.