子宫腺肌症患者临床特点回顾性分析

Clinical features of adenomyosis:a retrospective analysis

目的研究子宫腺肌症患者临床特点,为子宫腺肌症患者的临床管理提供理论基础。方法收集2012年3月至2015年9月于北京协和医院妇产科手术且确诊的291例子宫腺肌症患者资料,对临床检查结果进行统计学分析。结果子宫腺肌症患者发病的中位年龄为[34(29.0,40.0)]岁,确诊的中位年龄为[40(35.0,44.0)]岁。所有纳入患者中,9.3%的患者无症状,17.5%的患者因不孕症就诊,39.5%的患者发现月经异常,71.8%的患者伴疼痛症状。38.8%的患者合并子宫内膜异位症,58.1%的患者合并子宫肌瘤。72.4%的患者术前发现血清糖类抗原125(CA125)升高,超声扫描结果显示85.6%的患者子宫肌层的回声不均匀。接受子宫病灶切除术的患者208位(71.5%),接受全子宫切除伴或不伴附件切除术的患者83位(28.5%);接受经腹手术、腹腔镜手术及宫腔镜手术患者的比例分别为37.8%、59.5%和2.7%。结论子宫腺肌症患者发病年龄较轻,多伴有月经异常、疼痛及不孕症状,合并症以卵巢的子宫内膜异位症多见。因此,应根据子宫腺肌症患者的临床表现及生育要求制定个体化治疗方案。

Objective:To investigate the clinical and pathological features of uterine adenomyosis.Methods:The clinical records of 291 premenopausal patients who were operated and pathologically diagnosed with uterine adenomyosis in Department of Obstetrics and Gynecology at Peking Union Medical College Hospital from March 2012 to September 2015 were collected and analyzed.Results:The median age of disease onset of adenomyosis patients was[34(29.0,40.0)]years old,and the median age of diagnosis was[40(35.0,44.0)]years.Among all the included patients,9.3%of the patients were asymptomatic.17.5%of the patients with infertility,39.5%with abnormal menstruation and 71.8%with pain symptoms,38.8%of patients complicated with endometriosis,58.1%of patients complicated with uterine fibroids.Preoperative CA125 increased in 72.4%of the patients.85.6%of the patients showed an unequal echo of myometrium under the ultrasound scan.Totally,208 patients(71.5%)underwent lesion dissection and 83(28.5%)received hysterectomy with or without accessory resection.The proportion of patients undergoing abdominal surgery,laparoscopic surgery,and hysteroscopic surgery was 37.8%,59.5%and 2.7%,respectively.Conclusions:Patients with adenomyosis have a relatively young age of onset,and are often accompanied by menstrual abnormalities,pain and infertility.The most common complications are endometriosis of the ovary.Therefore,individualized treatment should be formulated according to the clinical manifestations and fertility requirements of patients with adenomyosis.