子宫腺肌症痛经发生因素临床分析

Influential Factors on the Incidence of Dysmonorrhea Caused by Uterine Adenomyosis

目的分析子宫腺肌症痛经的相关因素。方法对2004-01/2010-06月间133例病理确诊为子宫腺肌症的患者的病理资料及临床资料进行回顾性分析。结果临床症状为痛经者103例(77.4%):①腺体浸润肌层>80%39例(29.3%),其中37例存在重度痛经,2例中度痛经;腺体浸润肌层<80%94例(70.7%),其中4例存在重度痛经,24例存在中度痛经,36例存在轻度痛经。差异有统计学意义(χ2=106.674,P=0.000)。②浸润内膜有出血47例(35.3%),均有痛经,无出血86例(64.7%),其中56例有痛经。差异有统计学意义(χ2=21.171,P=0.000)。③异位内膜小岛<3个51例(38.3%),其中有痛经35例;3～5个41例(30.8%),其中有痛经31例;>5个41例(30.8%),其中有痛经37例。差异有统计学意义(χ2=6.194,P=0.045)。④血平均雌激素水平722.5 pmol/L,重度痛经组为952.7pmol/L,中度痛经组为673.8 pmol/L,轻度痛经组为541.1 pmol/L,差异有统计学意义(F=6.984,P=0.001)。血平均孕酮水平18.1μg/L,其中重度痛经组为21.8μg/L,中度痛经组为17.6μg/L,轻度痛经组为14.8μg/L。差异无统计学意义(F=2.929,P=0.058)。⑤子宫大小:重度、中度及轻度痛经组中子宫>孕6周者分别为32例(78.0%),22例(84.6%),28例(77.8%),差异无统计学意义(χ2=0.537,P=0.764)。结论子宫腺肌症痛经与腺体浸润程度、浸润内膜出血、异位内膜小岛数量及外周血雌激素水平呈正相关,而痛经程度与子宫大小及外周血孕激素水平无关。

Objective To analyze the associated factors of dysmonorrhea caused by uterine adenomyosis.Methods The pathological and clinical materials of 133 patients with adenomyosis confirmed by pathological analysis admitted from January 2004 to June 2010 were retrospectively analyzed.Results One hundred and three cases（77.4%） had dysmonorrhea.① 39 cases（29.3%） has above 80% adenoma infiltration into the uterine muscle,among whom 37 had severe dysmonorrhea and 2 had moderate dysmonorrhea.94 cases（70.7%） has less than 80% adenoma infiltration,among whom 4 had severe dysmonorrhea,24 had moderate dysmonorrhea and 36 had mild dysmonorrhea.②47 cases with bleeding in the infiltrated endometrium and 56 of 86 cases without bleeding had dysmonorrhea（χ2=21.171,P=0.000）.③ 35 of 51 cases with small endometriosial islands fewer than 3,31 of 41 cases with 3-5 islands and 37 of 41 cases with more than 5 islands had dysmonorrhea（χ2=6.194,P=0.045）.④The average blood estrogen was 722.5 pmol/L,and 952.7 pmol/L,673.8 pmol/L,541.1 pmol/L in the patients with severe,moderate and mild dysmonorrhea respectively（F=6.984,P=0.001）.The average progestion level was 18.1 μg/L,and 21.8 μg/L,17.6 μg/L,14.8 μg/L in the patients with severe,moderate and mild dysmonorrhea respectively（F=2.929,P=0.058）.⑤32,22,28 patients with uterus bigger than 6 weeks′ pregnance had severe,modereate and mild dysmonorrhea respectively（χ2=0.537,P=0.764）.Conclusion Dysmonorrhea is positively related with the depth of adenoma infiltration,the bleeding of the infiltrated adenoma,the number of endometriosial islands and the level of peripheral blood estrogen,while irrelevant with the uterus volume and the level of peripheral blood progestion.