子宫腺肌病87例诊治分析

目的：分析近年来子宫腺肌痛的发病情况、临床表现、诊断和治疗。方法：回顾性分析2000年1月-2002年12月本院收治的87例子宫腺肌痛患者的临床资料。结果：87例子宫腺肌痛患者占我院同期妇科住院人数的9．6％、妇科子宫切除手术的21．3％。术前痛经者58例(66．7％)，月经过多者35例(40．2％)，人流后急性腹疼3例(3．4％)。术前诊断为子宫腺肌病51例，诊断符合率为58．6％，B超诊断符合率为49．4％，血CA125测定阳性率为69．2％。除3例行腺肌瘤剔除术外，其余均行全子宫切除术，其中32例术前曾使用内美通、丹那唑、米非司酮、避孕1号等治疗达3个月以上，76．0％痛经明显缓解，但73．7％患者停药后第1个月经周期痛经即复发。结论：子宫腺肌病目前仍以手术治疗为主，治疗子宫内膜异位症的常用药物对子宫腺肌病痛经均有效，但停药后易复发。

Diagnosis and treatment of uterine adenoeyosis in 87 cases

Objective To investigate the incidence, clinical characteristics,diagnosis and treatment of uterine adenomyosis. Methods Clinical data of 87 patients with adenomyosis comfirmed by pathology from January 2000 to December 2002 admitted in our hospital were analyzed retrospectively. Results The incidence of adenomyosis was 9. 6% of total gynecological hospitalized patients and accounted for 21. 3% among all patients. Fifty-eight (66. 7%) cases of hystercectomy had dysmenorrhea and 35 (40. 2%)had menorrhagia. Three(3. 4%) had colic pain after induced abortion. Fifty-one cases were diagnosed as adenomyosis preoperatively,with 58. 6% diagnostic accuracy. The serum CA125 was positive in 69. 2%. All except 3 patients were treated with hysterectomy. Before operation, 32 patients had received hormone treatment, as gestrinone, danazol, mifepristone, estrogen or progestins for more than three months. Dysmenorrhea was relieved in 76. 0% of patients during the hormone medicinal treatment. But symptoms recurred in 73. 7% of cases at the first menstrual cycle after the cessation of treatment. Conclusion Hyserectomy remains the dominant treatment of adenomyosis up to now. Drugs for endometrioais is also effective for relieving dysmenorrhea in patients with uterne adenomyosis although the dysmenorrhea recurs rapidly when medical treatment is stopped.