摘要
目的 总结子宫附腔(ACUM)的临床特点,探讨其治疗方法及预后。方法 回顾性分析2017年1月—2023年12月河南省人民医院行手术治疗的9例ACUM患者的临床资料。记录痛经情况和位置,术前血生化、肿瘤标志物、超声及盆腔MRI检查结果,手术情况。随访至2024年3月,记录痛经缓解情况等。结果 9例平均年龄27.6岁,主要临床症状均为痛经进行性加重,6例疼痛位于患侧,3例位于骨盆中央。口服止痛药及避孕药后疼痛部分缓解或未缓解。术前血红蛋白均正常,2例糖类抗原125升高。9例均行子宫及附件超声检查,声像特征主要表现为肌壁间低回声或不均质回声,内可见内膜样高回声,均未合并泌尿系统畸形。5例行盆腔增强MRI扫描,其中3例提示肌壁异常信号,可见类圆形等T_1信号,T_2内部呈小条状高信号,外周呈环状低信号,考虑ACUM可能;2例提示肌壁异常信号,子宫腺肌症伴出血样改变。8例行腹腔镜下ACUM切除术,1例行开腹手术,病灶均完整切除,无术后并发症发生。随访至2024年3月,中位随访13个月,9例患者痛经完全缓解或明显减轻,无需使用止痛药物。2例术前糖类抗原125升高者术后1个月降至正常。结论 ACUM多发生于青年女性,临床表现为痛经进行性加重,可伴腺肌病灶,超声及MRI检查有助于明确诊断,手术完整切除病灶可有效缓解痛经。
Objective To investigate the clinical characteristics, treatment methods, and prognosis of accessory cavitated uterine mass(ACUM). Methods Nine patients with ACUM underwent surgical treatment in Henan Provincial People's Hospital from January, 2017 to December, 2023, and their clinical data were retrospectively analyzed. The degree and location of dysmenorrhea, preoperative blood biochemical indicators, tumor markers, ultrasound examination, pelvic MRI examination results, and surgical procedures were recorded. The follow up was conducted till March, 2024, to record the relief of dysmenorrhea. Results The average age of these 9 patients was 27.6 years old, and the main clinical symptoms were progressive worsening of dysmenorrhea. Six patients had pain on the affected side, and three patients had pain in the center of the pelvis. Oral and contraceptives were ineffective or only partially relieved dysmenorrhea. All patients had normal hemoglobin, and 2 patients had elevated level of carbohydrate antigen 125 before surgery. All 9 patients underwent uterine and adnexal ultrasound examination, and the ultrasound imaging features were intramural hypoechogenicity or heterogeneous echogenicity, with visible endometrial hyperechogenicity, and no urinary system abnormalities. Five patients underwent pelvic enhanced MRI scan, showing abnormal intramural signals in 3 patients, with circular T_1 signals, a small strip-like high signal in T_2, and a circular low signal around T_2, suggesting the possibility of ACUM;showing abnormal intramural signals in 2 patients, suggesting adenomyosis with blood-like changes.Eight patients underwent laparoscopic ACUM resection,and one underwent open surgery.All lesions were completely removed,and no postoperative complications occurred.The follow up was conducted till March,2024,with a median follow-up time of 13months,showing complete or significant relief of dysmenorrhea in 9patients,with no need for analgesics.The preoperative elevated carbohydrate antigen 125in 2patients showed a decrea
作者
徐志华
魏利
王轶英
樊茹佳
XU Zhihua;WEI Li;WANG Yiying;FAN Rujia(Department of Obstetrics and Gynecology,Henan Provincial People's Hospital,Zhengzhou University People's Hospital,Zhengzhou,Henan 450003,China)
出处
《中华实用诊断与治疗杂志》
2024年第7期695-698,共4页
Journal of Chinese Practical Diagnosis and Therapy
基金
河南省医学科技攻关计划省部共建项目(SBGJ202102019)。
关键词
子宫附腔
子宫畸形
痛经
accessory cavitated uterine mass
uterine malformation
dysmenorrhea
