无症状子宫黏膜下子宫囊性腺肌病一例诊治体会

子宫囊性腺肌病是子宫腺肌病的一种少见类型。报告1例通过宫腔镜诊断并治疗的位于子宫黏膜下且无明显症状的子宫囊性腺肌病患者情况。该病例病灶凸向宫腔,且无明显的临床症状,术前B超多次提示子宫壁或宫腔有异常表现,行宫腔镜检查时降低膨宫压力才发现位于黏膜下的2处病灶。在治疗过程中保留囊肿底部囊壁,使其成为子宫内膜的一部分,术后行3个月雌孕激素序贯治疗,最终通过体外受精-胚胎移植技术获得妊娠。通过对此特殊病例进行回顾性分析,加深对特殊位置的子宫囊性腺肌病的认识及诊断,当B超多次提示子宫壁或宫腔有异常表现,而宫腔镜检查却无明显异常时,应考虑黏膜下子宫囊性腺肌病的可能,建议降低宫内压后再观察宫腔内病灶。在治疗过程中也可采取“开窗术”,术后再给予雌孕激素序贯治疗从而改变妊娠结局。

Experience in Diagnosis and Treatment of Asymptomatic Submucous Uterine Cystic Adenomyosis

Cystic adenomyosis is a rare type of adenomyosis. We report a case of asymptomatic cystic adenomyosis in submucosa diagnosed and treated by hysteroscopy. In this case, the patient had no obvious clinical symptoms although the lesion protruded to the uterine cavity. Preoperative B-ultrasound repeatedly suggested abnormal manifestations in the uterine wall or uterine cavity. Two submucosal lesions were found only when the pressure of distention was reduced during hysteroscopy. The bottom wall of the cyst was preserved as part of the endometrium during treatment, followed by 3 months of sequential estrogen progesterone therapy. The pregnancy outcome was achieved through in vitro fertilization-embryo transfer. Through the retrospective analysis of this special case, we can deepen the understanding and diagnosis of cystic adenomyosis of uterus in a special location. When the abnormal manifestations of uterine wall or uterine cavity are repeatedly indicated by B-ultrasound, but no obvious abnormalities are found by hysteroscopy, the possibility of submucosal cystic adenomyosis should be considered, and the intrauterine lesions should be observed after the intrauterine pressure is reduced. In the treatment process, "fenestration" can also be adopted, followed by sequential therapy of estrogen plus progesterone to improve the pregnancy outcome.