子宫腺肌病合并静脉血栓栓塞症一例

doi:10.12280/gjfckx.20260337

摘要/Abstract

摘要：

子宫腺肌病患者除了月经过多、痛经、不孕等症状外，还存在凝血功能紊乱、高凝倾向及血栓形成倾向。报告1例患有子宫腺肌病合并下肢深静脉血栓、肺栓塞的患者，临床表现为异常子宫出血、下肢疼痛，经止血、抗凝治疗后行经腹全子宫切除术，术后病理证实子宫腺肌病病灶中存在血管内微血栓。术后随访1.5年，患者D-二聚体、糖类抗原125等指标恢复正常，双下肢超声提示堵塞的血管再通，无新发血栓。本病例提示，子宫腺肌病患者存在高凝及血栓形成倾向，在异常出血的同时易罹患血栓性疾病，诊疗过程中需关注患者动脉血氧饱和度及不适主诉，提高临床诊断率。子宫切除术后患者凝血指标逐渐恢复正常，这进一步提示子宫腺肌病与凝血功能紊乱密切相关，切除子宫或子宫腺肌病病灶或许可以逆转子宫腺肌病导致的高凝状态。

关键词: 子宫腺肌病, 血液凝固, 静脉血栓栓塞, 治疗, 预后

Abstract:

In addition to symptoms such as menorrhagia, dysmenorrhea, and infertility, patients with adenomyosis may present with coagulation disorders, a hypercoagulable state, and thrombotic tendency. This article reports a case of adenomyosis complicated by deep vein thrombosis of the lower extremity and pulmonary embolism. The patient presented with abnormal uterine bleeding and lower limb pain. After hemostatic and anticoagulant therapy, she underwent total abdominal hysterectomy. Postoperative pathology confirmed the presence of intravascular microthrombi within the adenomyosis lesions. During the 1.5-year follow-up, the patient's D-dimer levels and carbohydrate antigen 125 levels returned to normal, and ultrasonography of both lower limbs indicated recanalization of the occluded vessels, with no new thrombotic events. This case suggests that patients with adenomyosis exhibit a hypercoagulable and prothrombotic tendency, making them susceptible to thrombotic disorders even in the presence of abnormal bleeding. During diagnosis and treatment, close attention should be paid to the patient’s arterial oxygen saturation and subjective complaints to improve clinical detection. The gradual normalization of coagulation parameters after hysterectomy further indicates a close association between adenomyosis and coagulation dysfunction. Removal of the uterus or adenomyotic lesions may potentially reverse the hypercoagulable state induced by adenomyosis.

Key words: Adenomyosis, Blood coagulation, Venous thromboembolism, Therapy, Prognosis

沈文欣, 陈醒, 孙莹, 戴辉华. 子宫腺肌病合并静脉血栓栓塞症一例[J]. 国际妇产科学杂志, 2026, 53(4): 442-446.

SHEN Wen-xin, CHEN Xing, SUN Ying, DAI Hui-hua. Adenomyosis Complicated by Venous Thromboembolism: A Case Report[J]. Journal of International Obstetrics and Gynecology, 2026, 53(4): 442-446.

图/表 3

图1 肺动脉CTA图注：两肺动脉干及其分支内充盈缺损，右侧为著，如箭头所示。

图2 患者离体子宫的大体观注：A 子宫呈球形增大；B 切面见子宫壁显著增厚，可见散在出血点。

图3 子宫腺肌病病灶病理图注：A 可见子宫腺肌病病灶以及血管内微血栓，如箭头所示，HE染色×40，标尺=500 μm；B 可见子宫肌壁中多个血管内微血栓形成，如箭头所示，HE染色×100，标尺=100 μm。

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