14例阑尾子宫内膜异位症临床病理特征分析

Clinical and pathological characteristics analysis of 14 cases of appendiceal endometriosis

目的:分析阑尾子宫内膜异位症的临床病理特点。方法:回顾分析2005年8月至2022年4月病理确诊的14例阑尾子宫内膜异位症患者的临床资料。结果:患者发现阑尾子宫内膜异位症时中位年龄43.5(35.0,46.0)岁,小于30岁占7.1%(1例),30~40岁占28.6%(4例),40~50岁占50.0%(7例),大于50岁占14.3%(2例)。9例(64.3%)患者术前存在痛经症状,术后痛经症状均缓解。12例(85.7%)患者病理证实阑尾存在急慢性炎症,4例(28.6%)临床诊断为原发性不孕症。患者术前检查均未提示阑尾子宫内膜异位症,均为术后病理诊断。1例(7.1%)患者术前主要诊断为阑尾肿物,1例(7.1%)主要诊断为卵巢肿物,术前主要诊断为卵巢囊肿、急慢性阑尾炎、卵巢恶性肿瘤、子宫肌瘤各3例(21.4%)。4例(28.6%)因阑尾急慢性炎症或阑尾肿物切除阑尾,6例(42.9%)因术中见阑尾形态异常而切除阑尾,3例(21.4%)因卵巢恶性肿瘤常规切除阑尾,1例(7.1%)为右侧附件切除术中见阑尾与卵巢粘连紧密而切除阑尾。3例合并剥除卵巢囊肿、1例合并切除右侧卵巢,病理证实均存在卵巢子宫内膜异位囊肿;4例同时切除子宫及一侧或双侧附件,其中3例同时存在卵巢子宫内膜异位囊肿及子宫腺肌病,1例存在子宫腺肌病。阑尾子宫内膜异位位置:肌层7例(50%),外膜3例(21.4%),浆膜1例(7.1%),3例(21.4%)位于肌层及外膜;1例合并阑尾黏液腺瘤,1例合并阑尾黏液腺瘤及阑尾类癌。患者均经腹腔镜手术切除阑尾。结论:对于临床确诊子宫内膜异位症的孕龄期妇女,尤其存在反复右下腹疼痛的患者,妇科与外科医师需仔细鉴别排查阑尾子宫内膜异位症的可能。如果阑尾存在子宫内膜异位,会引起阑尾急、慢性炎症,通常需要手术治疗,需引起妇科及外科医师的高度重视。

Objective:To analyze the clinical and pathological characteristics of appendiceal endometriosis.Methods:A retrospective analysis was conducted on clinical data of 14 patients with pathologically confirmed appendiceal endometriosis diagnosed from Aug.2005 to Apr.2022.Results:The median age of patients diagnosed with appendiceal endometriosis was 43.5(35.0,46.0)years,with 7.1%(1 case)below the age of 30,28.6%(4 cases)aged 30-40,50.0%(7 cases)aged 40-50,and 14.3%(2 cases)above the age of 50.Among the patients,64.3%(9 cases)experienced dysmenorrhea before surgery,and their dysmenorrhea symptoms were r elieved after surgery.Pathological examination confirmed the presence of acute or chronic inflammation in 85.7%(12 cases)of the p atients.Clinical diagnoses of primary infertility were made in 28.6%(4 cases)of the patients.Preoperative examinations did not s uggest appendiceal endometriosis in any of the patients,and the diagnosis was made based on postoperative pathology.The main preoperative diagnoses were appendiceal masses in 7.1%(1 case)of the patients,ovarian masses in 7.1%(1 case),ovarian cysts,acute or chronic appendicitis,ovarian malignancies,and uterine fibroids in 21.4%(3 cases)respectively.As for the source of appendiceal specimens,28.6%(4 cases)had the appendix removed due to appendiceal inflammation or appendiceal masses,42.9%(6 cases)had the appendix removed due to abnormal morphology observed during surgery,21.4%(3 cases)had the appendix removed routinely during the resection of ovarian malignancies,and 7.1%(1 case)had the appendix removed due to close adhesion to the right ovary during right adnexectomy.Three cases involved the removal of ovarian cysts,and one case involved the removal of the right ovary;all pathologically confirmed the presence of ovarian endometriotic cysts.Four cases underwent concurrent hysterectomy with unilateral or bilateral adne-xectomy,among which three cases had both ovarian endometriotic cysts and adenomyosis,and one case had adenomyosis alone.The l ocations of appendiceal endometriosis were 50%(7 cases)in the muscular layer,21.4%(3 cases)in the outer membrane,7.1%(1 case)in the serosa,and 21.4%(3 cases)in both the muscular layer and outer membrane.Case 1 had concurrent appendiceal mucinous adenoma,and case 13 had concurrent appendiceal mucinous adenoma and appendiceal carcinoid.All patients underwent minimally invasive laparoscopic surgery to remove the appendix.Conclusions:For childbearing age women clinically diagnosed with endometriosis,e specially those who experience recurrent lower right abdominal pain,gynecologists and surgeons need to carefully consider the possibility of appendiceal endometriosis.If appendiceal endometriosis is present,it is highly likely to cause acute or chronic inflammation in the a ppendix,which often requires surgical treatment,and gynecologists and surgeons should pay high attention.