盆腔异位蜕膜在足月剖宫产术中的临床特征分析

Clinical features of ectopic decidua in term gestation

目的探讨在卵巢和胎盘激素的影响下,子宫腔以外出现典型的蜕膜组织而导致异位蜕膜性出血或急性产后出血性蜕膜病的生物学行为和病理机制,为临床准确诊断和及时救治提供参考资料。方法 2017年8月至2018年1月成都市青白江区妇幼保健院足月孕剖宫产术461例,发现3例异位蜕膜。我们对3例异位蜕膜进行临床特征分析和病理形态观察,并结合文献评估其健康风险和防治措施。结果 3例异位蜕膜患者无内异症史,曾痛经、不孕,或无症状,仅术中发现空泡状、充血灶、淤血斑块、实性结节、灶性出血,镜下见蜕膜化间质细胞聚集,细胞核无异型性。因异常血管生成、炎症反应的临床特点,异位蜕膜可发生急性产后出血性蜕膜病等重症病例,为临床全面认识、科学防治提供了依据。讨论孕期异位蜕膜见于子宫浆肌层、卵巢、大网膜、宫颈、阴道等,常缺乏临床症状和体征而易被误诊、漏诊,病因不清,未受到临床广泛重视,需警惕广泛出血威胁母儿生命的潜在风险,做好及时手术干预、维护母胎健康等应对措施。

Objective To explore the biological behavior and pathologic mechanism of ectopic decidua hemorrhage or acute postpartum hemorrhagic deciduosis caused by typical decidua tissue outside the uterine cavity under the influence of ovarian and placental hormones,and provide reference for accurate diagnosis and effective treatment. Methods From August 2017 to January 2018,there were 461 term-pregnant women undergoing ceasarian section in maternal and child health hospital of Qingbaijiang district,of whom 3 cases with ectopic deciduas were diagnosed. The clinical characteristics and microscopic features of 3 cases were retrospectively analyzed. The risk assessment to human health as well as effective control measures of ectopic deciduas were further elucidated along with the relevant references. Results Three patients with ectopic decidua generally had no obvious clinical symptoms or endometriosis,though dysmenorrheal and infertility might happen before pregnancy. Only an intraoperative incidentally finding of specific lesions varied from vacuolar plaques,hyperemia,vascular nodules,solid nodules and local hemorrhagic change. Under light microscope,the decidualized stroma revealed large polygonal cell aggregates,without nuclear atypia. Due to the clinical features of abnormal angiogenesis and inflammatory reactions,ectopic decidua may cause severe cases such as acute postpartum hemorrhagic deciduosis,which could provide a basis for clinical comprehensive understanding and scientific prevention and treatment. Conclusion Ectopic decidua can happen in uterine seromuscular layers,ovary,great epiploon,cervix,vagina and so on,which is easy to be misdiagnosed or fails to be examined due to asymptom and nonspecific physical signs. It hasn＇t been unequivocally clarified and widely recognized,nor earned extensively considered for rarely life-threatening haemorrhagic deciduosis in the prepartum and postpartum period,which must be taken effective first-aid measures such as surgical intervention to protect maternal-fetal health.