子宫非典型息肉样腺肌瘤138例临床分析  

Clinical Analysis of 138 Cases of Atypical Polypoid Adenomyoma of the Uterus

作　　者：张丽娟[1] 段爱红[1] 盛洁[1] 

机构地区：[1]首都医科大学附属北京妇产医院妇科,北京100026

出　　处：《中国微创外科杂志》2016年第8期681-684,共4页Chinese Journal of Minimally Invasive Surgery

摘　　要：目的探讨子宫非典型息肉样腺肌瘤（atypical polypoid adenomyoma,APA）的临床特点、诊治方法及预后。方法回顾性分析2005年6月-2015年6月我院138例APA的临床资料。年龄22-78岁,平均48.9岁,绝经前77例（55.8%）,绝经后61例（44.2%）。26例无妊娠史,14例合并不孕症。异常阴道出血是最常见症状（92例,66.7%）,41例（29.7%）无明显症状,但其中95.1%（39/41）超声提示异常。结果 135例行宫腔镜检查,其中119例（88.1%）镜下见单发病灶。138例病理均诊断APA,其中59例（42.8%）合并子宫内膜病变,包括内膜增生55例,癌变4例。术后随访10-115个月,（46.8±23.1）月,失访6例。单纯经宫腔镜病灶切除47例,术后辅助药物治疗31例,术后补充手术治疗47例。复发2例,保留子宫病例中的复发率2.6%（2/76）。7例合并或发展为癌,总癌变率5.3%（7/132）,无死亡。6例宫腔镜切除病灶后妊娠,其中4例术前为不孕症患者。结论 APA是良性肿瘤,有低度潜在恶性可能,临床预后总体良好。经宫腔镜完整切除病灶是治疗APA的有效方法,应根据年龄、有无生育要求个体化治疗,均需密切随访。Objective To analyze the clinical characteristics,diagnosis and prognosis of atypical polypoid adenomyoma（ APA） of the uterus. Methods Clinical data of 138 cases of APA admitted in our hospital from June 2005 to June 2015 were retrospectively analyzed. The mean age was 48. 9 years old,ranged from 22 to 78 years old. There were 77 cases（ 55. 8%） of premenopause and 61 cases（ 44. 2%） of post-menopause. There were 26 cases having no pregnancy history,and 14 of them had a history of infertility. The most common clinical symptom was irregular vaginal bleeding（ 92 cases,66. 7%）,while 41 cases（ 29. 7%）were free of symptoms. The ultrasound showed positive findings in uterus cavity or endometrial uneven in 95. 1%（ 39 /41）asymptomatic cases. Results A total of 135 cases underwent hysteroscopy,indicating single polypoid neoplasm in 119 cases（ 88. 1%）. Pathological diagnosis was APA in all the 138 cases and in combination with endometrial lesions in 59 cases（ 42. 8%）,including 55 cases of endometrial hyperplasia and 4 cases of cancer. All the patients,except 6 lost cases,were followed up for 10-115 months（ average,46. 8 ± 23. 1 months）. There were 47 cases of hysteroscopic resection of the lesion,31 cases of drug therapy after the surgery,and 47 cases of supplementary surgery. There were 2 recurrent cases,the recurrence rate being 2. 6%（ 2 /76） in those with uterus preservation. There were 7 cases of accompanied or deteriorated carcinoma, with a total rate of malignant transformation of 5. 3%（ 7 /132）. No fatal case was noted. Six patients were pregnant after the hysteroscopic resection of the lesion,and 4 of them were previously diagnosed as having infertility. Conclusions Almost benign tumor with good clinical prognosis,APA has a low potential for malignant transformation. Hysteroscopy with complete excision of the lesion should be a preferred treatment method. The patients should be treated individualized and given strict follow-ups.

关 键 词：非典型息肉样腺肌瘤 癌 宫腔镜 子宫切除术 

分 类 号：R737.33[医药卫生—肿瘤]