子宫非典型息肉样腺肌瘤的临床治疗分析

目的子宫非典型息肉样腺肌瘤(atypical polypoid adenomyoma,APA)较少见,临床对其特点尚未充分认识,存在治疗过度和治疗不足,本文旨在分析总结APA的临床特点及治疗经验。方法回顾性分析北京妇产医院收治的10例APA的临床诊疗情况及结局。结果 APA最常见症状为异常子宫出血及不孕,部分患者同时合并子宫内膜病变。本组所有病例均经宫腔镜"四步诊治法"完整切除病灶并行子宫内膜多点活检,据病理结果 ,3例进一步行子宫切除,1例行子宫内膜切除;药物辅助治疗2例。所有患者随诊6~34个月,均无复发。结论宫腔镜"四步诊治法"结合病理检查是确定临床治疗方案的基础,对于高度结构异型指数APA、或肌层浸润、或同时合并子宫内膜病变等高危因素的患者应行子宫切除,保留子宫的患者术后应辅助孕激素治疗;对无上述高危因素的患者可保留子宫随诊,临床预后良好。

Hysteroscopy used in atypical polypoid adenomyoma treatment

Objective To analyze the clinical characters of atypical polypoid adenomyoma（APA）and the explore how to select the therapeutic scheme.Methods Data of ten cases of APA who underwent hysteroscopy in the mini-invasive center of Beijing Obstetrics and Gynecologic Hospital Affiliated to Capital Medical University from June 2005 to June 2008 were analyzed retrospectively.Results The most common symptoms of APA were abnormal uterine bleeding and infertility.All cases were underwent hysteroscopic＂four-step＂technique and for each step a pathologic analysis was done.Based on the pathologic diaghosis,three cases were performed hysterectomy and one case underwent trans-cervical endometrium resection.Two cases were administered progesterone.All cases were under follow up（6-34 monthes）and no relapse occurred.Conclusions APA-H,myometrial invasion and endometrial hyperplasia coexisting are indications for hysterectomy.Progestin should be taken after operation.Others who have no high risk factors don＇t need hysterectomy but should be under follow up.