青春期子宫内膜异位症临床特征与诊断分析

Analysis of clinical features and diagnosis of adolescent endometriosis

目的探讨青春期子宫内膜异位症的临床特征与诊断，提高对该病的认识。方法对北京妇产医院2003年2月至2011年8月期间收治的39例13—21周岁的子宫内膜异位症患者的临床资料进行回顾性分析。结果青春期子宫内膜异位症39例患者，以盆腔痛就诊者10例，占25．7％；痛经就诊者13例，占33．3％；痛经渐进性加重13例，占33．3％；血清糖类抗原（CA）125〉35U／ml19例，占48．7％，B型超声提示盆腔包块者30例，占76．9％。患者均根据腹腔镜检查或开腹探查手术中所见确定临床分期，I期9例（23．1％），Ⅲ期16例（41．0％），Ⅳ期14例（35．9％），且Ⅲ期及Ⅳ期患者术后病理回报确诊为子宫内膜异位症。结论青春期子宫内膜异位症易漏诊，要重视渐进性加重的痛经；盆腔检查中有无官旁包块很重要；CA125升高与本病有相关性；B型超声可以筛查盆腔异常包块，美国生育协会修正的标准分期法分期较高时多发现附件区肿块；腹腔镜检查可提高子宫内膜异位症早期发现水平。

Objective To discuss the clinical features and diagnosis of adolescent females endometriosis. Methods From 2003 to 2011, 39 cases of aged 13 -21 years old patients with endometriosis were retrospectively analyzed. Results Among 39 patients adolescent endometriosis, 10 cases （25.7%） had pelvic pain; 13 cases （33.3 % ） had dysmenorrhea; 13 cases （ 33.3 % ） aggravated dysmenorrhea progressively ; serum carbohydrate anti- gen 125 （CA） of 19 cases（48.7% ） was more than 35 U/ml; B type ultrasound showed that 30 cases（76.9% ） had pelvic mass. All patients determined clinical staging according to laparoscopy or laparotomy exploration. 9 cases （23.1%） were I period, 16 cases （41.0%） were m period and 14 cases （35.9%） were 1V period. Patients in Ill and IV period were diagnosed of endometriosis postoperative pathology. Conclusions Adolescent endometriosis can be easily misdiagnosed. The presence of palace beside the bag piece in pelvic examination is very important. El- evated CA125 is associated with the disease. B type ultrasound can screen abnormal pelvic mass. Higher r-AFS classification can find attachment area mass easily. Laparoscopy can improve the level of early detection of endometriosis.