青春期子宫内膜异位症13例临床分析

Endometriosis in Adolescence: an Analysis of 13 Cases

目的 探讨青春期子宫内膜异位症（endometriosis,EMT）的特点、诊断和治疗.方法 回顾分析2005年6月～2011年4月手术确诊的13例年龄≤20岁青春期EMT的临床资料.手术方法包括腹腔镜或开腹子宫内膜异位囊肿剔除,4例合并生殖道梗阻性畸形同期行整形手术解除梗阻.7例术后辅助药物治疗.结果 8例腹腔镜手术时间35～125min,平均50.6 min;术中出血10 ～120 ml,平均50.9 ml.4例腹腔镜联合宫腔镜手术时间78 ～245 min,平均129.7 min;术中出血10 ～300 ml,平均115.0 ml.1例开腹手术时间120 min,术中出血150 ml.无生殖道畸形9例行腹腔镜手术8例,开腹手术1例.按照美国生育协会修正的标准分期法（r-ASF）进行分期：Ⅰ期2例,Ⅱ期1例,Ⅲ期7例,Ⅳ期3例.10例随访6～72个月,平均48.6月,1例术后1年复发,9例症状缓解.结论 青春期EMT患者常合并生殖道畸形,主要症状为痛经或下腹痛,确诊依赖手术及病理诊断,手术治疗后根据患者情况选择药物辅助治疗.

Objective To investigate the clinical features,diagnosis and management of endometriosis in adolescents.Methods A retrospective study was carried out to analyze the clinical data of 13 adolescents （aged less than or equal to 20） with endometriosis admitted to our hospital between June 2005 and April 2011.Surgical procedures included laparoscopic or abdominal endometriosis cyst resection.Four patients with genital tract obstruction deformity underwent plastic surgery concurrently.Results The operation time of 8 cases of laparoscopic surgery was 35-125 min,with an average of 50.6 min ; blood loss was 10-120 ml,with an average of 50.9 ml.The operation time of 4 cases of laparoscopy combined with hysteroscopy was 78-245 min,with an average of 129.7 min; the blood loss was 10-300 ml,with an average of 115.0 ml.The operation time of 1 case of laparotomy was 120 min,and the blood loss was 150 ml.Of the 9 patients without genital tract deformity,8 patients underwent laparoscopic surgery and 1 patient underwent open surgery.According to the revised American Fertility Society（AFS） classification,2 cases were in stage Ⅰ,1 case in stage Ⅱ,7 cases in stage Ⅲ,and 3 cases in stage Ⅳ.Ten cases were followed up for 6-72 months （average,48.6 months）,during which one case recurred one year after operation and the symptoms of 9 cases were relieved.Conclusions Adolescent endometriosis is often accompanied with genital tract deformity,and the main symptoms are dysmenorrhea or pelvic pain.Surgery and pathology are required to make a definite diagnosis of endometriosis.The application of postoperative medical therapy should be based on individual situations.