子宫内膜腺肌瘤样息肉91例临床分析

Analysis of Clinical Features and Treatment Options of 91 Cases of Endometrial Adenomyomatous Polyps

目的：探讨子宫内膜腺肌瘤样息肉的临床特点及诊治，以提高对该病的认识。方法：回顾性分析91例子宫内膜腺肌瘤样息肉患者的临床特点、诊治及复发情况。结果：9l例患者年龄20～72岁，平均46.70岁；65例绝经前期患者平均体重指数（BMI）22.33±3.23kg／m^2，23例绝经后患者平均BMI25.38±4.14kg／m^2。临床表现中月经改变或异常阴道流血71例，占78.02％。89例阴道彩超检查提示边界清晰的宫腔或宫颈管占位。子宫内膜腺肌瘤样息肉病灶可分布于官腔的任何位置，以后壁最常见（51.95％，40／77）。91例均经术后病理检查确诊。术后随访7～257个月，在50例取得随访资料的病例中宫腔镜下电切术42例，术后临床症状明显好转，仅5例复发。结论：子宫内膜腺肌瘤样息肉的临床表现、阴道彩超特征、肿块形态位置无明显特异性，病理检查是明确诊断的金标准。宫腔镜下电切术是子宫内膜腺肌瘤样息肉的首选治疗方式。

Objective：To investigate the clinical features and treatment options of adenomyomatous polyp of the uterus. Methods：Retrospective analysis of the clinical features ,treatments and recurrences of 91 cases of adenomyomatous polyp of the uterus. Results：91 patients ranged in age from 20 to 72（mean age 46, 70） years. The average body mass index（BMI） of 65 premenoopausal patients was 22. 33 ±3. 23 kg/m^2 ; and that of 23 postmenopausal patients was 25. 38±4. 14 kg/m^2. 71 patients（78. 2%） had menstrual changes or abnormal vaginal bleeding,and 89 patients were found with sharply marginated occupations in uterine cavity or cervix by transvaginal ultrasound. Adenomyomatous polyps could be found in any location of the uterine cavity, butthe most common location is the posterior wa11（40/77,51.95% ）. Among 50 patients with follow-up periods ranging from 7 to 257 months ,42 patients underwent hysteroscopic polypectomy and got great relief of the clini- cal symptoms. Recurrence was observed in only 5 patients. Conclusions ：The clinical manifestations,transvaginal ultrasonic features and hysteroscopic appearances of adenomyomatous polyp of the uterus all lack specificity,and pathology is the gold standard for the diagnosis of this disease. Hysteroscopic polypectomy should be the prior treatment choice for adenomyomatous polyp of the uterus.