40例深部浸润型子宫内膜异位症的临床特点、MRI影像表现及治疗效果分析

Clinical Features, MRI Findings and Curative Effect of 40 Cases of Deep Infiltrating Endometriosis

【目的】探讨深部浸润型子宫内膜异位症（DIE）临床特点、MRI影像表现及治疗效果。【方法】回顾性分析2014年2月至2016年2月确诊的85例子宫内膜异位症患者临床、MRI影像学及治疗相关资料，通过与非DIE人群比较．6-结DIE临床特点，观察DIE患者MRI影像学表现及治疗效果。【结果】85例患者中病理证实DIE40例．DIE组重度痛经、性交痛、附件囊肿活动度、宫骶韧带结节发生率分别为92．5％、65．0％、72．5％、67．5％显著高于非DIE组（n=45）的33．3％、11．1％、42．2％、17．8％，差异有统计学意义（P〈0．05），DIE组阴道直肠隔结节5例，后穹窿蓝色结节15例，而非DIE组无。MRI显示DIE患者累及子宫宫骶韧带27例（子宫骶骨韧带增厚、两侧不对称或韧带内结节）；T1wI、T2WI序列多以高信号为主。治疗总有效率90．6％；术后6个月患者临床症状评分、CAl25水平较术前均明显下降（P〈0．05）。【结论】DIE患者以重度痛经、性交痛为其典型临床症状，阴道直肠隔结节、后穹窿蓝色结节为DIE判断敏感表现；MRI对DIE病变范围准确显示，在DIE术前诊断中有重要作用；根据临床症状及MRI检查结果采取相应的治疗方法效果良好。

[ Objective] To investigate the clinical features, MRI image representation and curative effect of deep in- filtrating endometriosis （DIE）. [ Methods] Clinical data of 85 patients with endometriosis diagnosed in our hospital from February 2014 to February 2016 were retrospectively analyzed, including the clinical, MRI imaging and treatment. The clinical features of DIE were compared with those of non DIE group, and the MRI imaging findings and therapeutic effects of DIE were observed. [ Results]40 cases in 85 patients were confirmed with DIE pathologically, the incidence of severe dys- menorrhea and dyspareunia, adnexal cyst activity, uterosaeral hgament nodules of the DIE group were 92.5%, 65%, 72.5%, 67.5% ,which were significantly higher than those in the non DIE group （ n =45） 33.3%, 11.1%, 42.2%, 17.8%. The difference was statistically significant （ P 〈0.05）. 5 cases of vaginal rectum nodules were found in the DIE group, posterior fornix blue nodules in 15 cases, but none of them were found in the non DIE group. MRI showed that accumulated uterine uterosacral ligament were found in 27 cases （uterosacral ligament thickening, asymmetry or ligament nodules） ; T1WI, T2WI sequences are mainly high signal. The total effective rate of treatment was 90.6%. The clinical symptom score and CA125 level 6 months after the operation were significantly lower than those before operation （ P 〈0.05） . [Conclusion] The typical clinical symptoms of patients with DIE are severe dysmenorrhea and dyspareunia. Rectovaginal nodules and posterior fornix blue nodules are sensitive manifestationsfor diagnosis of DIE; MRI can accurately display the range of DIE, which plays an important role in preoperative diagnosis of DIE. According to the clinical symptoms and MRI results, the effect of corresponding treatment methods will be good.