国际妇产科学杂志

国际妇产科学杂志 ›› 2017, Vol. 44 ›› Issue (2): 167-170.

• 论著 • 上一篇    下一篇

子宫内膜非典型息肉样腺肌瘤24例临床分析

周巧云，刘玉环，夏恩兰   

  1. 100038  北京，首都医科大学附属复兴医院宫腔镜中心
  • 收稿日期:2016-12-22 修回日期:2017-02-08 出版日期:2017-04-15 发布日期:2017-05-18

Clinical Analysis of 24 Cases Atypical Polypoid Adenomyoma of Endometrium

ZHOU Qiao-yun，LIU Yu-huan，XIA En-lan   

  1.  Hysteroscopic Center，Fuxing Hospital，Capital Medical University，Beijing 100038，China
  • Received:2016-12-22 Revised:2017-02-08 Published:2017-04-15 Online:2017-05-18

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摘要：
     目的：探讨子宫内膜非典型息肉样腺肌瘤（atypical polypoid adenomyoma，APA）患者的诊治方法。方法：回顾性分析2006年1月—2015年6月首都医科大学附属复兴医院收治的24例APA患者的临床特点、诊治情况及预后，总结经验指导治疗。17例（70.8%）患者临床表现为阴道异常出血，1例（4.2%）阴道排液，3例（12.5%）超声提示宫腔占位，3例（12.5%）原发性不孕。24例患者均行宫腔镜手术，术后病理确诊。结果：24例均经病理明确诊断。宫腔镜检查和阴道彩色超声检查子宫内膜息肉及子宫黏膜下肌瘤的检出率分别为61.1%、68.4%和11.1%、15.8%，差异均无统计学意义（P＞0.05）。手术时间5～40 min，平均为（23.7±8.6）min，术中出血5～20 mL，平均为（6.5±2.9）mL。术后随访1～10年，失访4例。3例患者宫腔镜子宫内膜息肉电切术后行全子宫切除术，术后随访无异常。1例3个月后复查仍为APA，再次宫腔镜手术，术后肌注促性腺激素释放激素激动剂（GnRHa），复查病理正常后宫腔放置左炔诺孕酮宫内缓释系统，至今随访2年无异常。1例术后8年因子宫内膜上皮内瘤变行子宫切除术，余15例至今随访无异常；2例不孕患者术后妊娠并足月分娩。结论：宫腔镜电切术作为APA的一种有效的治疗方式，具有定位准确、手术创伤小、复发率低的优点，但因有病变复发及恶变可能，术后仍应密切随访。
    【关键词】 

关键词:  子宫内膜肿瘤, 腺肌瘤, 息肉, 宫腔镜, 预后

Abstract: Objective：To study the clinical features, diagnosis, treatment and prognosis of patients with atypical polypoid adenomyoma (APA). Methods：This is a retrospective study of 24 cases who suffered from APA admitted in Fuxing Hospital, Capital Medical University from January 2006 to June 2015. Their clinical features, diagnosis, treatment and prognosis were analyzed. The clinical feature of 17 cases (70.8%) were vaginal bleeding, 1 case (4.2%) vaginal discharge, 3 cases (12.5%) primary infertility. Ultrasound had shown occupied lesions within uterine cavity in 3 patients (12.5%). Twenty two patients were performed hysteroscopic surgery. Diagnosis was confirmed by pathological report. Results：Diagnosis of 24 cases were confirmed by pathologic report. The diagnosis of polyp by hysteroscopy and color ultrasound were 61.1% and 68.4% separately. The diagnosis of submucous myoma by hysteroscopy and color ultrasound were 11.5% and 15.8% separately. The differences were no significantly. The operating time was (23.7±8.6) min (5-40 min), the operating bleeding was (6.5±2.9) mL (5-20 mL). Postoperative follow-up consisted 1 to 10 years for 24 cases. Four cases lose follow-up. Three patients were performed hysterectomy after hysteroscopic polypectomy and postoperative follow-up was normal. At 3 months later hysteroscopic second look still shown APA in 1 case who was performed hysteroscopic polypectomy again and intramuscular injection GnRHa, till pathological report was normal levonorgestrel-releasing intrauterine system(LNG-IUS) was inserted into uterine cavity. Up to now 2 years follow-up there was no abnormalities. One case was performed hysterectomy 8 years later because of endometrial intraepithelial neoplasia. Fifteen cases follow-up so far no abnormality. There were 2 infertile patients got pregnancy and term delivery after surgery. Conclusions：As an effective treatment of APA hysteroscopic surgery has many advantages: positioning accuracy, mini-invasive and low recurrence rate. Owing to APA had the possibility of recurrence and malignant change, after surgery continuously and closely follow-up is still important.

Key words: Endometrial neoplasms, Adenomyoma, Polyps, Hysteroscopes；Prognosis

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