子宫内膜异位性疾病在MRKH综合征患者中的调查

发布时间：2018-02-12 09:21

本文关键词： MRKH综合征子宫内膜异位症子宫腺肌病上皮化生学说 MRKH综合征子宫腺肌病　出处：《浙江大学》2014年博士论文　论文类型：学位论文

【摘要】：目的：通过对MRKH综合征(Mayer-Rokitansky-Kuster-Hauser Syndrome)患者中子宫内膜异位症和子官腺肌病的发病调查,探讨MRKH综合征合并子宫内膜异位性疾病的可能机制。方法：回顾性分析浙江大学医学院附属妇产科医院从1999年1月1日至2013年12月31日收治的219例MRKH综合征患者的病例资料,分析其临床特征,并比较有正常内膜组和无正常内膜组的患者中子宫内膜异位症和子宫腺肌病的发病率差异。结果：219例MRKH综合征患者中,171例(78.08%)无正常内膜,其中2例合并子宫腺肌病,1例合并子宫内膜异位症；48例(21.92%)有正常内膜,其中7例合并子宫腺肌病,6例合并子宫内膜异位症。有正常内膜组与无正常内膜组的MRKH综合征患者中子宫内膜异位症的发病率有显著差异(p0.05)；有正常内膜与有始基子宫但无正常内膜的MRKH综合征患者中子宫腺肌病的发病率亦有显著差异(p0.05)。结论：子宫内膜异位症和子宫腺肌病在有正常内膜的MRKH综合征患者中的发病率显著高于无正常内膜的MRKH综合征患者,提示正常内膜在子宫内膜异位性疾病的发生发展中有重要作用；同时无正常内膜的MRKH综合征患者仍可发生子宫内膜异位症和子宫腺肌病,推测体腔上皮化生学说与子宫内膜异位性疾病的发病有关。第二部分无正常内膜的MRKH综合征合并子宫腺肌病2例中文摘要子宫腺肌病被认为是子宫内膜的腺体和间质侵入子宫肌层内生长所致的一种良性子宫病变,似乎不可能发生在没有正常内膜的患者上。在此我们报道两例无正常内膜的Mayer-Rokitansky-Kuster-Hauser (MRKH)综合征患者发生子宫腺肌病的例子。两名患者均因原发性闭经及周期性下腹痛就诊；妇科检查提示正常外阴发育、阴道盲端及盆腔肿块,超声检查提示“不均质低回声包块,无宫腔线”；腹腔镜手术中发现增大的始基子宫,双侧卵巢正常；术前CA125均升高,始基子宫切除术后恢复至正常水平。术后病理报告示子宫腺肌病,未见正常内膜。无正常内膜的MRKH综合征患者可以发生子宫腺肌病,提示子宫腺肌病的发生可能与苗勒管的残余化生有关。
[Abstract]:Objective: to investigate the pathogenesis of endometriosis and adenomyosis in patients with MRKH syndrome (Mayer-Rokitansky-Kuster-Hauser Syndrome) and to explore the possible mechanism of MRKH syndrome complicated with endometriosis. Methods: the data of 219 patients with MRKH syndrome admitted from January 1st 1999 to December 31st 2013 in the affiliated Obstetrics and Gynecology Hospital of Zhejiang University Medical College were retrospectively analyzed. The incidence of endometriosis and adenomyosis were compared between normal endometrium group and non-normal endometrium group. Results there was no normal endometrium in 171 of the 219 MRKH syndrome patients (including 2 cases with adenomyosis and 1 case with endometriosis, 48 cases with endometriosis) with normal endometrium. The incidence of endometriosis in 7 cases with adenomyosis and 6 cases with endometriosis was significantly different between those with normal endometrium and those without normal endometrium (p 0.05), normal endometrium with normal endometrium and primary base with normal endometrium. The incidence of adenomyosis in patients with MRKH syndrome without normal endometrium was also significantly different (P 0.05). Conclusion: the incidence of endometriosis and adenomyosis in patients with MRKH syndrome with normal endometrium is significantly higher than that with MRKH syndrome without normal endometrium. The results suggest that normal endometrium plays an important role in the occurrence and development of endometriosis and that endometriosis and adenomyosis can still occur in patients with MRKH syndrome without normal endometrium. It is inferred that the supraluminal metaplasia theory is related to the pathogenesis of endometriosis. Part two MRKH syndrome without normal endometrium with adenomyosis: a report of 2 cases. Adenomyosis is thought to be a benign uterine lesion caused by the invasion of the endometrial glands and stroma into the myometrium of the uterus. It seems unlikely to occur in patients without normal endometrium. Here we report two cases of adenomyosis in patients with Mayer-Rokitansky-Kuster-Hauser 's syndrome without normal endometrium. Both patients were treated for primary amenorrhea and periodic lower abdominal pain. Gynecological examination showed normal vulva development, vaginal mass at the blind end and pelvic mass, ultrasonic examination showed "uneven hypoechoic mass without uterine cavity line", enlarged primary uterus and normal bilateral ovaries were found during laparoscopic surgery, and CA125 was increased before operation. After primary hysterectomy, it returned to normal level. The postoperative pathological report showed that adenomyosis was not seen in normal endometrium. Adenomyosis could occur in patients with MRKH syndrome without normal endometrium. The results suggest that the occurrence of adenomyosis may be related to the residual metaplasia of Mullerian canal.
【学位授予单位】：浙江大学
【学位级别】：博士
【学位授予年份】：2014
【分类号】：R711.71

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