子宫肌腺症的临床病理特点及手术指征的探讨

Study on clinico-pathological features and indications of operation on patients with adenomyosis

目的：探讨子宫肌腺症的临床病理特点及手术指征。方法：2004年1月至12月手术治疗且病理证实为子宫肌腺症340例，其中全子宫切除284例，保守手术（子宫肌腺症病灶切除术）56例，回顾分析其临床病理特点并探讨手术方式及指征。结果：340例子宫肌腺症中合并子宫内膜异位囊肿95例（27．94％），合并子宫肌瘤148例（43．5％），合并贫血95例（27．9％），合并子宫内膜息肉20例（5．9％）。痛经组与无痛经组患者合并不孕症差异无统计学意义（P〉0．05），两组合并内膜息肉有显著的统计学差异（P〈0．01），痛经者合并内膜息肉是非痛经组的5倍，95％CI为0．079～0．509。两组合并子宫内膜异位囊肿有显著的统计学差异（P〈0．01）。痛经患者合并卵巢子宫内膜异位症的风险是无痛经患者的3．369倍，95％CI为1．699～6．681。多因素Logistic回归分析表明，绝经前、月经量多和子宫大的患者易并发卵巢子宫内膜异位囊肿；年轻、分娩次数多和痛经重的患者易并发子宫内膜息肉；绝经前年轻女性和子宫体积大的患者易并发子宫肌瘤。分析不同手术途径表明：腹腔镜组年龄偏低，贫血、不孕比例明显增高。结论：对年轻合并性交痛、肛门坠痛等症状，伴有贫血或不孕患者首选腹腔镜检查／手术；子宫较大、B超提示合并肌瘤或既往有剖宫产史，估计盆腔粘连重者选择开腹手术；合并子宫脱垂、尿失禁等盆底组织缺陷性疾病选择阴式途径完成。保留子宫的手术可以根据患者主要症状、手术医师的技能和仪器来选择术式。对年龄大且无生育要求，合并贫血、子宫肌瘤，服药有严重副作用或无明显疗效的可行全子宫切除术。

Objective ：To study on clinico-pathological features and indications of operation on patient with adenomyosis. Methods：A cohort study was performed on 340 patients after hysterectomy （284 cases） or biopsy （ 56 cases） for adenomyosis histologically. Results： In 340 cases,95 （27.94%） were complicated with endometriosis, 148 （43.5%） were complicated with myoma,95（27.94% ） were complicated with anaemia,20（5.9% ） were complicated with endometrial polyps. There was no difference between dysmenorrhea and non-dysmenorrhea group in infertility （ P 〉 0.05 ）. The risk complicated with endometrial polyps and endometriosis is higher in dysmenorrhea group than in normal group（ P 〈0.01 ）. The OR value was 5. 001, and 3. 369,95% CI was 0.079 to 0.509 and 1. 699 to 6.681 ,respectively. Logistic analysis was as follows, hypermenorrhea, pre-menopause and hysterauxesis were independent risk factors complicated with endometriosis. The delivery times, young age and dysmenorrhea were independent risk factors complicated with endometrial polyps. Young age and hysterauxesis are independent laparosc risk factors complicated ope group. Conclusion： with myoma. Anaemia, sterility and young Laparoscope procedure is better for those age were common in young patients complicated with anaemia, sterility, algopareunia and anus pain. Open abdomen procedure is better for the those complicated with hysterauxesis, myoma, cesarean section historyand serious adhesion. Vagina route is better for the those complicated with pelvic organs prolaps. The choice of operational modelity preserving uterus relys on patient symptom, doctorg technical skill and equipment available. The indications of hysterectomy for adenomyosis include the older patient without fertility requirement, severe anaemia, the situation complicated with myoma, no effect on treatment, serious side effect on drugs.