子宫腺肌症的诊断与治疗

An Analysis of 446 Cases About the Diagnosis and Treatment of Uterine Adenomyosis

目的：分析子宫腺肌症（AM）的临床资料以指导诊断与治疗。方法：回顾性分析了AM446例临床资料。结果；446例AM患者占同期妇科子宫切除的18．9％；平均年龄为（39．5±2．5）岁。90．6％为经产妇，82．5％有刮宫、人流术史，14．6％有剖宫产史。86．1％患者因月经过多或经期延长就诊，术前平均血红蛋白为（108．7±5．1）∥L，贫血者33．4％。75．1％有痛经，中、重度痛经占71．9％；性交痛者占15．7％。术前86．6％患者子宫增大。临床诊断符合率为51．2％；经阴道超声诊断符合率为73．1％；血CA125测定阳性率63．1％。病理证实40．4％合并子宫肌瘤，48．2％合并卵巢子宫内膜异位囊肿或盆腔子宫内膜异位症。术中发现51．5％患者子宫及双附件与周围肠管或大网膜粘连。患者全部行手术治疗，其中392例开腹手术，43例腔镜下手术，30例行保留子宫的手术方式，11例经阴道手术。腺肌瘤剔除术16例（腔镜下手术13例），子宫楔型切除24例（腔镜下手术17例），单纯子宫切除术146例，子宫切除＋单侧附件切除228例，子宫切除＋双侧附件切除32例。38例AM合并子宫内膜异位症患者术前曾内美通或米非司酮或雌孕激素类药物治疗，其中28例达3个月以上，24例痛经症状缓解或消失，23例停药2～3个月经周期痛经复发，月经过多者9例停药3个月经周期内月经量未增多。结论：刮宫、人流术、经产妇易患AN；月经过多或经期延长较痛经常见；病史询问、妇科检查、联合经阴道超声检查和血CA125测定有助诊断。子宫切除仍为主要手术方式．保留子宫及腹腔镑手术有增多的趋势．

Objective： To investigated the clinical characteristics of uterine adenomyosis in diagnosis and treatment. Methods： Clinical data of 446 cases with uterine adenomyosis from two hospitals confirmed by pathological examination were analyzed retrospectively. Results：The incidence of adenomyosis was 18.9% among total patients hysterectomy. In 446 cases ,404（90.6% ） cases were post- pregnancy, 368 （82.5%）cases were complicated with the history of artificial abortion, 65 （ 14.6% ）cases were compheated with cesarean section,401 （86.1% ） cases had menorrhagia or menostaxis, 149（33.4% ） cases had anaemia,335（75.1% ） cases had dysmenorrhea,70（ 15.7% ） cases had painful intercourse and 386（86.6% ） patients had hysteranxesis. Preoperatively, 273 （51.2 % ） cases were diagnosed clinically. The serum CA- 125 was positive in 63.1% of cases measured, and 326 （73.1% ） cases were diagnosed by intra- vaginal ultrasonography. All patients were treated by operation. Among them, 392 cases were treated with hysterectomy by open abdomen procedure,43 cases with laparoscopy procedure, 30 cases with operational modality preserving uterus, 11 cases treated by vagina route.There were 260 cases complicated with endometriosis. 28 cases comphcated with adenomyosis and endometriosis had received hormone treatment, e.g. gestrinone, mifepristone, estrogen or progestins for more than three mouths. Dysmenorrhea was relieved in 24 eases during the treatment, but 23 cases recurred at the second to third menstrual cycle after the cessation of hormone treatment. It was useful to menorrhagia. Conclusions： The history of artificial abortion and pregnancy were the risk factors of development of adenomyosis. The complain of menorrhagia or menostaxis were more common than dysmenorrhea in chnical practice. The detail of history, physical examination, combining with intravaginal ultrasonography and serum CA- 125 measured were better for improving the diagnosis. Hysterectomy remains the dominant treatment of adenomyosis. The choice of operational modality preserving uterus and laparoscope procedure is better for more and more patients.