子宫附腔畸形的诊断及预后分析一例

doi:10.12280/gjfckx.20240674

摘要/Abstract

摘要：

子宫附腔畸形（accessory cavitated uterine malformations，ACUM）是一种罕见的发育性米勒管畸形，临床表现主要为痛经或慢性盆腔疼痛，诊断明确后经腹腔镜或开腹等手术切除畸形肿块后痊愈。报告1例青年女性，痛经进行性加重3年余，需口服止痛药缓解，妇科超声提示：子宫左侧壁探及一等回声结节，大小36 mm×35 mm×33 mm，其内可见似内膜样回声，厚11 mm，残角子宫可疑。行腹腔镜探查术，子宫正常大小，于左侧圆韧带附着下方处见一直径4 cm的囊性腺肌瘤样结节外凸向阔韧带，双侧输卵管及卵巢发育正常，完整剥除肌瘤样包块后，切开肌壁见少量子宫内膜组织及陈旧性积血，病理确诊为ACUM，术后随访症状消失。临床上应加强对本病的认识，并注重对多次超声检查结果进行对比分析，争取早诊断并及时治疗。

关键词: 子宫附腔畸形, 痛经, 骨盆痛, 诊断, 预后

Abstract:

Accessory cavitated uterine malformations (ACUM) is a rare developmental Müllerian duct malformation with clinical manifestations mainly dysmenorrhea or chronic pelvic pain, which is cured by surgical resection of the malformed mass, such as laparoscopy or open surgery, after the diagnosis is clear. We report a case of a young woman with progressive worsening of dysmenorrhea for more than 3 years, requiring oral painkillers for relief. Gynecological ultrasound showed that an equal echogenic nodule was detected in the left wall of the uterus with a size of 36 mm×35 mm×33 mm, which was seen to resemble endometrial echoes with a thickness of 11 mm, and a suspicious residual angel of the uterus. After laparoscopic exploration, the uterus was normal in size, and a cystic adenomyoma-like nodule with a diameter of 4 cm was seen below the attachment of the left round ligament, and the development of bilateral fallopian tubes and ovaries was normal; after complete removal of the myoma-like mass, a small amount of endometrial tissue and old blood were seen in the incised myometrial wall, and the pathology of the disease confirmed the diagnosis of ACUM, and the symptoms disappeared in the postoperative follow-up. Clinical awareness of this disease should be strengthened, and focus on multiple ultrasound results for comparative analysis, for early diagnosis and timely treatment.

Key words: Accessory cavitated uterine malformations, Dysmenorrhea, Pelvic pain, Diagnosis, Prognosis

豆苗苗, 郑婧, 张航, 杨博, 张春洁, 刘志杰. 子宫附腔畸形的诊断及预后分析一例[J]. 国际妇产科学杂志, 2025, 52(1): 84-88.

DOU Miao-miao, ZHENG Jing, ZHANG Hang, YANG Bo, ZHANG Chun-jie, LIU Zhi-jie. Diagnosis and Prognosis Analysis of Accessory Cavitated Uterine Malformations: A Case Report[J]. Journal of International Obstetrics and Gynecology, 2025, 52(1): 84-88.

图/表 7

图1 2023年1月6日妇科超声图

图2 2023年1月9日MRI图注箭头所示为左侧宫角附近圆形空腔肿物。

图3 2023年1月30日妇科超声图

图4 宫腔镜检查图

图5 腹腔镜下肿物大体形态

图6 术后肿物剖开图

图7 术后病理图（HE×100）注：图中矩形区域为腔内被覆的子宫内膜。标尺=100 μm。

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