宫腔镜治疗子宫息肉样腺肌瘤22例临床分析

目的探讨子宫息肉样腺肌瘤的宫腔镜表现和治疗。方法2000年10月～2006年2月我院收治的子宫息肉样腺肌瘤患者22例。其中息肉样腺肌瘤18例，非典型性息肉样腺肌瘤4例。全部患者均接受宫腔镜下子宫内膜息肉切除术（TCRP）治疗，术后随访2～42个月。结果22例患者经超声检查和宫腔镜检查均不能将其与子宫内膜息肉或粘膜下肌瘤区分。绝经前妇女占40．91％（9／22）。绝经后妇女占59．09％（13／22）。患者的平均体重指数（BMI）是（26．5±4．10）。绝经后患者的平均卵巢体积为（1．57±2．49）cm^2；绝经前和绝经后患者子宫内膜厚度分别为（0．94±0．66）cm和（0．71±0．72）cm。1例绝经后息肉样腺肌瘤患者宫腔镜治疗后1年。因阴道出血再次行宫腔镜检查，病理检查显示为非典型性息肉样腺肌瘤，同时合并子宫内膜非典型性增生，行子宫全切术。结论息肉样腺肌瘤是一种特殊类型的子宫内膜息肉，在临床和宫腔镜下没有特异性表现，必须由病理确诊；非典型性腺肌瘤可能发生在息肉样腺肌瘤的基础上。

Clinical analysis of 22 cases with polypoid adenomyoma of uterus treated by hysteroscopy

Objective To discuss the features and treatments of polypoid adenomyoma of uterus under hysteroscope.Methods Twenty-two polypoid adenomyoma were diagnosed pathologically and treated by TCRP in our hospital from Oct,2000 to Feb,2006.Eighteen of them were typical polypoid adenomyoma,the other four were atypical.Two out of the four atypical polypoid adenomyoma underwent hysterectomy,and the other 2 received hormone therapy.Results Neither B ultrasound nor diagnostic hysteroscopy could identify polypoid adenomyoma from endometrial polyps and submucous fibroma.A postmenopausal woman,who had typical polypoid adenomyoma and TCRP one year ago,had to repeat hysteroscopy and TCRP for irregular bleeding.The mass within her uterus was diagnosed as an atypical polypoid adenomyoma accompanied by atypical hyperplasia of endometrium.She underwent hysterectomy at last.Conclusions Polypoid adenomyoma should be diagnosed pathologically.Atypical polypoid adenomyoma might developed from typical adenomyoma.