阴道子宫内膜异位症18例临床分析

目的:探讨阴道子宫内膜异位症(内异症)的临床特点和治疗效果。方法:回顾性分析我院2003年1月至2005年10月收治的18例经病理证实为阴道内异症患者的临床资料。结果:阴道内异症独立存在者13例(72.2%),合并盆腔内异症者5例(27.8%)。前组性交痛及合并妇科良、恶性肿瘤的比例高于后组,而合并不孕的比例较后组低。所有患者中8例行保守性手术治疗,其中4例术后加用GnRHa治疗3个月;其余10例均行根治性手术治疗。平均随访18.6月,共有2例复发(11.1%),均见于肿块直径≥3 cm、行阴道局部切除未用药物治疗者。总共半年累积复发率13.3%(2/15),保守性手术复发为25%(2/8),其半年累积复发率40.0%(2/5);保守性手术术后加用药物治疗者及行根治性手术者无复发。各种术式之间比较,无明显统计学差异(P>0.05)。结论:阴道子宫内膜异位症与常见的盆腔内异症相比较,有其特殊之处。其发生机制可能与盆腔内异症不同,尚有待进一步研究。

The Biological Behavior and Prognosis of Vaginal Endometriosis

Objective:To explore the biological characteristics of vaginal endometriosis and compare its prognosis with pelvic endometriosis.Methods:A retrospective study was made of 18 patients who were pathologically diagnosed as vaginal endometriosis,identified to the Hospital affiliated to Fudan University during the time from Jan 1st,2003 to Oct 31th,2005.Results:Vaginal endometriosis appeared in 13 cases as isolated(72.2%) while in other 5 cases coexisted with pelvic endometriosis(27.8%).The proportion of deep dyspareunia and gynecological tumors was higher in the former group than in the latter one.Whereas the incidence of infertility was lower in the former group.All patients underwent surgery.8 patients received conservative surgery and among them 4 patients received post-operative administration of GnRHa for 3 months.The other 10 patients received radical surgery.All patients were followed up,with the average time of 18.6 months.15 patients were followed more than 6 months.The overall recurrence was 11.1%(2/18).The 2 recurrent cases both underwent resection of vaginal masses but not with post-operation medications and the diameters of their vaginal masses were more than 3 cm.The cumulative rate of recurrence for 6 months was 13.3%(2/15) overall and was 40%(2/5) after conservative surgery.There was no recurrence after radical surgery or conservative surgery plus administration of GnRHa.However,no significant difference was observed among different groups(P>0.05).Conclusions:Compared with the common pelvic endometriosis,vaginal endometriosis has its own characteristics of biological behavior.The pathogenesis of vaginal endometriosis may be different from pelvic endometriosis and needs to be further studied.