子宫腺肌病与子宫肌瘤的临床比较

A comparative analysis of clinical characteristics of adenomyosis and hysteromyoma

目的探讨子宫腺肌病与子宫肌瘤的临床特点,提高对于子宫腺肌病术前诊断率。方法以5年来妇产科子宫切除术后病理证实为子宫腺肌病的130例为A组;并随机选择同期子宫切除术后病理证实的子宫肌瘤患者150例为B组,对2组患者年龄分布、既往史、临床症状、术前诊断,B超检查、血清CA125水平进行比较。结果 2组患者均好发于生育年龄妇女,常有月经过多或经期延长(P>0.05)。子宫腺肌病术前诊断率(72.31%),出现痛经(73.08%)、性交痛较多(33.08%),但继发性贫血少(15.38%);具有特征性的超声表现;血清CA125(74.5±68.3)U/ml,水平明显升高。结论子宫腺肌病诊断的金标准是病理诊断,但其既往史、特有症状、B超改变、血清CA125水平增高仍是诊断该病的重要参考指标,并可与子宫肌瘤进行术前鉴别。

Objective To investigate differences in clinical characteristics of adenomyosis and hysteromyoma so as to improve preoperative diagnosis rate of adenomyosis. Methods 130 cases of adenomyosis confirmed by pathological examination after hysterectomy in past 5 years and 150 cases of hysteromyoma confirmed by pathological examination after hysterectomy in the same period were randomly selected and their age distribution, past history, clinical symptoms, preoperative diagnosis, ultrasonographic findings and serum level of CA125 were compared. Results Both the diseases were commonly seen in women of childbearing age and the clinical manifestations of the patients were hypermenorrhea or prolonged menstrual period （ No difference between the two groups ,P 〉0.05 ）. The preoperative diagnosis rate of adenomyosis was 72.31% , and the patients with adenomyosis usually suffered from dysmenorrhea （73.08%） , dyspareunia （ 33.08% ） and seldom secondary anemia （ 15.38% ） . Ultrasonographic examination showed some characteristic findings and the serum level of CA125 （ 74.5±68. 3U/ml） increased evidently. Conclusion Though the golden standard of diagnosis of adenomyosis is pathologic diagnosis , the past history , specific clinical symptoms , ultrasonographic findings , and elevated serum CA125 level are also important reference indexes to differentiate adenomyosis with hysteromyoma before operation.