青春期子宫内膜异位症53例的临床特点及术后分析

Clinical characteristics and postoperative analysis of 53 cases of adolescent endometriosis

目的分析青春期子宫内膜异位症(EMs)的临床特点、诊断方法、治疗手段及术后情况,探究生殖道畸形对青春期EMs患者的影响,以期尽早识别、尽早治疗和阻止病情进展。方法选取2008年5月~2021年10月期间在福建省妇幼保健院妇科住院的EMs患者作为研究对象,收集患者的临床资料,并评估术前药物使用效果、辅助检查的准确性,以及术后随访症状改善、复发和妊娠等情况。结果最终共有53例青春期EMs患者完成随访。痛经是青春期EMs患者的主要症状,其他常见症状包括周期性疼痛、胃肠道症状和泌尿系统症状等。盆腔MRI与金标准手术病理诊断结果的诊断符合率最高(73.58%),彩色多普勒超声(60.38%)和血清CA125水平(52.83%)的诊断符合率较低。与生殖道非畸形组相比,生殖道畸形组确诊距初潮年龄的时间差较短,确诊年龄、症状出现的年龄更早,痛经发生率、CA125水平、术前用药比例、痛经疼痛程度为重度的比例以及接受术后辅助治疗的比例更高,但在术后复发率和术后正常妊娠率等方面与非畸形组无显著差异(P>0.05)。结论青春期EMs发病年龄较早,但常被延误诊疗,患者临床表现以疼痛为主,常伴有其他系统症状,盆腔MRI有助于明确诊断,生殖道畸形患者的临床症状可能更严重,治疗需求更复杂。

Objective To analyze the clinical characteristics,diagnostic methods,treatment methods and postoperative conditions of adolescent endometriosis(EMs),and to explore the influence of genital tract malformation on adolescent EMs patients,so as to identify,treat and prevent the progression of the disease as soon as possible.Methods Patients with EMs who were hospitalized in the department of gynecology of Fujian Maternity and Child Health Hospital from May 2008 to October 2021 were selected as the research objects.The clinical data of the patients were collected,and the effect of preoperative drug use,the accuracy of auxiliary examination,and postoperative follow-up symptoms improvement,recurrence and pregnancy were evaluated.Results A total of 53 adolescent EMs patients completed the follow-up.Dysmenorrhea is the main symptom of adolescent EMs patients.Other common symptoms include periodic pain,gastrointestinal symptoms and urinary system symptoms.The diagnostic coincidence rate of pelvic MRI and gold standard surgical pathological diagnosis was the highest(73.58%),and the diagnostic coincidence rate of color Doppler ultrasound(60.38%)and serum CA125 level(52.83%)was lower.Compared with the non-genital tract malformation group,the time difference between the diagnosis and the age of menarche was shorter,the age of diagnosis and the age of symptoms were earlier,the incidence of dysmenorrhea,the level of CA125,the proportion of preoperative medication,the proportion of severe dysmenorrhea pain and the proportion of postoperative adjuvant treatment were higher in the genital tract malformation group,but there was no significant difference in the postoperative recurrence rate and the postoperative normal pregnancy rate between the genital tract malformation group and the non-genital tract malformation group(P>0.05).Conclusion The onset age of adolescent EMs is earlier,but it is often delayed in diagnosis and treatment.The clinical manifestations of patients are mainly pain,often accompanied by other systemic symptoms.Pelvic MRI is helpful to confirm the diagnosis.The clinical symptoms of patients with genital tract malformation may be more serious and the treatment needs are more complicated.