国际妇产科学杂志

国际妇产科学杂志 ›› 2020, Vol. 47 ›› Issue (6): 637-641.

• 论著 • 上一篇    下一篇

宫腔镜治疗子宫内膜息肉样腺肌瘤48例临床分析

任健，周琦，张丽娟，李婷   

  1. 100026  北京，首都医科大学附属北京妇产医院妇科
  • 收稿日期:2020-05-27 修回日期:2020-08-16 出版日期:2020-12-15 发布日期:2020-12-11
  • 通讯作者: 周琦，E-mail：zq2004023@sina.com E-mail:zq2004023@sina.com

A Clinical Analysis of 48 Cases with Polypoid Adenomyoma of the Uterus Treated by Hysteroscopy

REN Jian, ZHOU Qi, ZHANG Li-juan, LI Ting   

  1. Department of Gynecology, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing 100026, China
  • Received:2020-05-27 Revised:2020-08-16 Published:2020-12-15 Online:2020-12-11
  • Contact: ZHOU Qi, E-maｉｌ：zq2004023@sina.com E-mail:zq2004023@sina.com

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摘要： 目的：探讨子宫内膜息肉样腺肌瘤（PA）的临床特点及诊治方法，提高对该病的认识。方法：收集2016年2月—2019年2月于首都医科大学附属北京妇产医院妇科行宫腔镜治疗的子宫内膜息肉样腺肌瘤患者48例，回顾性分析其临床特点、诊治情况，其中典型性息肉样腺肌瘤（TPA）26例，非典型性息肉样腺肌瘤（APA）22例。结果：48例患者年龄26～72岁，平均（50.0±10.4）岁。年龄≥40岁者41例，占85.42%；绝经者22例，占45.83%。APA组体质量指数（BMI）为（26.3±3.9） kg/m2，TPA组BMI为（24.0±4.0）kg/m2，2组差异有统计学意义（P=0.046）。48例患者中22例（45.83%）有异常子宫出血，19例（39.58%）为体检发现。空腹血糖APA组为（5.8±0.7）mmol/L，TPA组为（5.4±0.6） mmol/L，差异有统计学意义（P=0.043）。超声检查显示24例（50%）患者可见宫内占位性肿物，21例（43.75%）患者表现为子宫内膜回声不均或不均质增厚。48例患者均行宫腔镜下病灶切除，单发病灶占83.33%。术后21例APA患者予高效孕激素持续用药3～6个月， 其中1例随访1年后因复发行全子宫切除术。结论：PA患者多为40岁以上中老年女性，异常子宫出血为主要临床症状，超声检查多可见宫内占位性病灶，以单发为主，宫腔镜手术治疗安全有效。高BMI及空腹血糖水平可能与APA发病有关，APA患者应长期密切随访。

关键词: 子宫内膜息肉样腺肌瘤；, 子宫内膜肿瘤；, 人体质量指数；, 血糖；, 宫腔镜检查

Abstract: Objective：To analyze the characteristics, diagnosis and treatment of the polypoid adenomyoma (PA) of the uterus and to improve the understanding of the disease. Methods: A total of 48 patients with PA treated with hysteroscopy in gynecology department from February 2016 to February 2019 at Beijing Obstetrics and Gynecology Hospital affiliated to Capital Medical University were collected, and their clinical characteristics, diagnosis and treatment were retrospectively analyzed. There were 26 cases of typical polypoid adenomyoma (TPA) and 22 cases of atypical polypoid adenomyoma (APA). Results: 48 patients were 26 to 72 years old, with a mean of (50.0±10.4) years old. There were 41 patients aged ≥ 40 years old, accounting for 85.42%; 22 menopausal patients, accounting for 45.83%. The BMI in the APA group was (26.3±3.9) kg/m2 and that in the TPA group was (24.0±4.0) kg/m2, the difference was statistically significant(P=0.046); 22 of the 48 patients (45.83%) had abnormal uterine bleeding symptoms, and 19 patients (39.58%) were found by physical examination. The fasting blood glucose level in the APA group was (5.8±0.7) mmol/L, and that of the TPA group was (5.4±0.6) mmol/L, the difference was statistically significant (P=0.043). Ultrasound showed that 24 patients (50%) could see intrauterine masses, and 21 patients (43.75%) showed uneven endometrial echo or thickening.  All 48 patients underwent hysteroscopic resection of lesions, and single lesions accounted for 83.33%. 21 patients with APA were given high-efficiency progestin for 3-6 months after operation.  One patient with APA had relapse, and was issued with total hysterectomy after followed up for one year. Conclusions: Most patients of the PA were middle-aged and elderly women over 40 years old. Abnormal uterine bleeding was the main clinical symptom. Most ultrasound examination of patients showed the intrauterine occupying lesions and the number of polyp was mainly single. Hysteroscopic surgery was proved to be safe and effective. High BMI and the fasting blood glucose level might be related to the incidence of APA and patients with APA should be closely followed.

Key words: Polypoid adenomyoma;, Endometrial neoplasms;, Body mass index;, Blood glucose, Hysteroscopy