子宫腺肌症286例临床分析

目的 通过分析子宫腺肌症临床资料,以总结临床经验.方法 回顾分析20011年1月～2005年12月收治的286例子宫腺肌症患者临床资料.结果 286例子宫腺肌症患者占同期妇科手术的7.3%,术前诊断为子宫腺肌症195例,诊断符合率68.2%.随访1～5年,经腹及经腹腔镜子宫切除术后患者痛经缓解率100%,腹腔镜筋膜内子宫切除术患者痛经缓解率95.3%.保守性手术配合药物治疗术后1年痛经缓解率91.4%,术后2年缓解率81.0%.有生育要求者共58例,术后妊娠22人次,足月妊娠14例,自然流产7例,孕6个月子宫破裂1例.结论 子宫腺肌症治疗目前仍以手术为主,子宫切除可达根治目的.对于年轻的患者,应制定个体化治疗方案.

A clinical analysis of 286 cases of adenomyosis of uterus

Objective To investigate clinical characteristics,diagnosis and treatment of adenomysis of uterus.Methods Clinical data of 286 patients with adenomysis of uterus confirmed by histo-pathology admitted in our hospital over a period from January 2001 to December 2005 were analyzed retrospectively.Results 286 operations for adenomyosis of uterus accounted for 7.3% of total gynecological operations and 25.1% of all hysterectomy in the same period.174(60.8%) patients were operated on for dysmenorrhea and 125patients(43.7%) for menorrhagia and menstrual disorders.182(63.3%)patients were associated with endometriosis,137(47.9%)patients were associated with hysteromyomas and 54 patients(18.9%) were associated with pelvic inflammatory disease.195 cases were diagnosed as adenomysis of uterus preoperatively with 68.2% diagnostic accordance rate.164 patients received total laparoscopic hysterectomy,while 64 patients received classical intrafascial supracervical hysterectomy.42 patients received laparoscopic adenomyosis resection or wedge resection of uterus.16 patients underwent laparoscopic biopsy of the foci.After operation,122 patients received hormone replacement treatment(such as gestyinone,danazol,mifepristone,Marvelon) for more than three months(42.7%) and were followed-up for 1~5 years.The relief rate of dysmenorrhea in women treated with either peritoneal or laparoscopic hysterectomy was 100%,while that in women treated with classical intrafascial supracervical hysterectomy was 95.3%.Dysmenorrhea was relieved in 91.4% of patients treated with conservative operation combined hormonotherapy after one year and dysmenorrhea was relieved in 81.0% of the patients after two years.Hypermenorrhea was relieved in 42.3% of the patients.58 patients desired to preserve her fertility and 22 patients had pregnancy after operation,of which,14 women had term delivery and 7 women had spontaneous abortion and 1 woman had uterine rupture at 6 months of gestation.Conclusion Hysterectomy remains the dominant and radical treatment of adenomyosis of uterus up to now.But for younger patients who desire to preserve her fertility,the age,histopathological type of the lesion and family economic condition all should be comprehensively analyzed to work out an individualized treatment scheme for the patients.