不典型子宫附腔畸形一例

doi:10.12280/gjfckx.20230876

摘要/Abstract

摘要：

子宫附腔畸形（accessory cavitated uterine malformation，ACUM）是一种罕见的梗阻性器官畸形，常在年轻女性中发现，主要临床表现是进行性加重的痛经和复发性盆腔痛，常需与囊性子宫腺肌病、先天性子宫囊肿及残角子宫等鉴别。目前手术是其最有效的治疗方式。报告1例已婚女性患者，痛经4年，阵发性下腹痛，向会阴和背部放射，进行性加重，需口服止痛药。2023年8月经妇科阴道超声示：子宫偏右侧约3.5 cm×2.7 cm不均质包块，内可见范围约1.1 cm×0.6 cm小无回声区，肿物性质待查。行腹腔镜探查术，子宫正常大小，居中，色红润。双侧输卵管、卵巢外观未见异常。子宫右侧近宫角处，输卵管与右侧圆韧带间见一稍向外突起，剥离出一直径约3 cm质硬肌性肿物，切开后见一腔隙，内见暗红色液体流出，完整切除肿物后送检，经病理确诊为ACUM。术后随访症状消失。

关键词: 子宫附腔畸形, 痛经, 超声检查, 磁共振成像, 病例报告

Abstract:

Accessory cavitated uterine malformation (ACUM) is a rare obstructive organ malformation, often found in young women, with the main clinical manifestations of progressively aggravated dysmenorrhea and recurrent pelvic pain. It should be differentiated from cystic adenomyopathy, congenital uterine cyst and residual horn uterus. At present, surgery is the most effective treatment. We report a married female patient with dysmenorrhea for 4 years, paroxysmal lower abdominal pain radiating to the perineum and back, progressively aggravated, requiring oral painkillers. In August 2023, gynecological vaginal ultrasound showed that the right side of the uterus was about 3.5 cm×2.7 cm heterogeneity nodular echo, the visible range was about 1.1 cm×0.6 cm small echoless area, the nature of which was to be determined. Laparoscopic exploration was performed. The uterus was normal in size, centered, and rosy. The appearance of bilateral fallopian tubes and ovaries was normal. On the right side of the uterus near the uterine horn, there was a slightly outward protrusion between the fallopian tube and the right round ligament. A hard muscular mass of about 3 cm in diameter was exfoliated from the protrusion. After incision, a space was found with dark-red fluid flowing out. The tumor was completely resected for examination and the diagnosis was confirmed as ACUM by pathological analysis. The symptoms disappeared in the post-operative follow up.

Key words: Accessory cavitated uterine malformation, Dysmenorrhea, Ultrasonography, Magnetic resonance imaging, Case reports

王晓利, 陈屹, 郑新春, 曹艳花. 不典型子宫附腔畸形一例[J]. 国际妇产科学杂志, 2024, 51(2): 148-151.

WANG Xiao-li, CHEN Yi, ZHENG Xin-chun, CAO Yan-hua. A Case Report of Atypical Accessory Cavitated Uterine Malformation[J]. Journal of International Obstetrics and Gynecology, 2024, 51(2): 148-151.

图/表 4

图1 盆腔MRI图注：A 轴位，T1WI，箭头示异常信号。B 冠状位，T2WI，箭头示异常信号。

图2 经阴道二维超声图注：箭头示子宫右侧不均质包块内无回声区。

图3 CDFI图注：子宫右侧不均质包块周围见血流信号。

图4 术后病理图注：A 切面见囊腔，腔内覆子宫内膜腺体及间质，标尺为200 μm（HE染色×25）。B 囊腔周围平滑肌组织中见散在子宫内膜异位腺体及间质，标尺为100 μm（HE染色×50）。

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