青春期子宫内膜异位症合并生殖道畸形的临床分析

发布时间：2018-06-18 05:26

  本文选题：青春期 + 子宫内膜异位症　； 参考：《郑州大学》2017年硕士论文

【摘要】：背景子宫内膜异位症(endometriosis,EMs,简称内异症)是育龄期妇女常见疾病,主要以盆腔包块、下腹痛与痛经、不孕为表现,是一种严重影响女性卵巢储备功能及生育能力的疾病。青春期(世界卫生组织,world health organization,WHO对青春期界定是10~19岁)子宫内膜异位症发病率逐年增加,亦有相关文献报道其发病率并不低于育龄期。异位子宫内膜来源尚未阐明,被国内外学者公认的学说是Sampson提出的“经血逆流学说”。据此学说推论,生殖道梗阻畸形应是内异症发病的高危因素。生殖道畸形不同类型临床表现不一,比较复杂,给诊断和治疗带来一定难度,且由于青春期年龄、心理等的特殊性,疾病往往延误诊治。目的探讨青春期子宫内膜异位症合并生殖道畸形的临床特点、诊断及治疗,以期为疾病早期诊断、早期治疗提供参考。方法收集2012年7月~2015年12月间经我院妇科确诊的青春期子宫内膜异位症71例患者的临床资料,其中合并生殖道畸形15例,对其临床资料进行回顾性分析,选取患者的发病年龄、初潮年龄、月经情况、临床特征、盆腔及泌尿系彩超检查、核磁共振成像(Magnetic Resonance Imaging,MRI)检查、血清糖类抗原125(carbohydrate antigen 125,CA125)、手术方式及术中情况等作为主要观察指标。术后病人定期随访,随访结果专人记录。女性的生殖道畸形分类依据中华妇产科学(第3版)进行,内异症分期根据1985年美国生育协会修订的内异症分期标准(Revised American Fertility Society,r-AFS)进行。临床数据采用SPSS21.0软件进行统计学分析,计量资料用(?)±s表示,采用t检验。结果1.71例青春期子宫内膜异位症中合并生殖道畸形15例,均为梗阻性畸形,发生率21.1%,其平均年龄15.0±0.7岁,未合并生殖道畸形者平均发病年龄17.9±0.5岁,两者比较差异有统计学意义(P0.05)。2.青春期子宫内膜异位症合并生殖道畸形者中因痛经进行性加重或周期性下腹痛伴原发性闭经就诊者占80%。3.盆腔彩超术前诊断生殖道畸形与手术相符率达80%,MRI达90%。4.生殖道畸形中合并泌尿系畸形发生率66.7%,其中残角子宫及阴道斜隔患者均合并同侧肾缺如。5.内异症病变部位卵巢发生率达73.3%,r-AFS分期以中重度(Ⅲ、Ⅳ期)多见60%。6.所有患者行腹腔镜手术清除盆腔子宫内膜异位病灶,联合宫腔镜或阴式手术解除生殖道梗阻,随访13例,腹痛症状缓解率92.3%,复发率低7.7%结论1.青春期子宫内膜异位症合并生殖道畸形常见症状为痛经进行性加重或周期性腹痛伴原发性闭经。盆腔彩超及MRI有助于诊断,及时手术解除梗阻预后良好。2.生殖道畸形常合并泌尿系畸形,对意外发现的泌尿系畸形患者应行盆腔彩超,以早期发现生殖道畸形。
[Abstract]:Background: endometriosis (EMs) is a common disease in women of childbearing age. It is characterized by pelvic mass, lower abdominal pain, dysmenorrhea and infertility. It is a disease that seriously affects the ovarian reserve function and fertility of women. The incidence of endometriosis in puberty (defined by the World Health Organization (WHO) as 10 ~ 19 years old) has increased year by year, and the incidence of endometriosis has been reported to be no lower than that of reproductive age. The origin of ectopic endometrium has not been elucidated. According to the theory, the malformation of reproductive tract obstruction should be a high risk factor for the development of endometriosis. The clinical manifestations of different types of reproductive tract deformities are different and complex, which brings some difficulties to diagnosis and treatment, and due to the particularity of puberty and psychology, the diagnosis and treatment of diseases are often delayed. Objective to investigate the clinical features, diagnosis and treatment of pubertal endometriosis complicated with genital tract malformation in order to provide reference for early diagnosis and treatment of the disease. Methods from July 2012 to December 2015, 71 cases of pubertal endometriosis diagnosed by gynecology in our hospital were collected, 15 of them were complicated with genital tract malformation. The clinical data were analyzed retrospectively and the age of onset was selected. Age of menarche, menstruation, clinical features, pelvic and urinary system color ultrasonography, magnetic resonance imaging (MRI), serum carbohydrate antigen 125(carbohydrate antigen 125 and CA125, operation mode and intraoperative condition were the main indexes. The patients were followed up regularly and the results were recorded. The classification of female genital tract malformation was conducted according to Chinese obstetrics and gynecology (3rd edition), and the endometriosis staging was carried out according to the revised American Fertility Society r-AFSs revised by the American Fertility Association in 1985. The clinical data were analyzed by SPSS 21.0 software. Results 1. Among the 71 cases of puberty endometriosis, 15 cases were complicated with genital tract malformation, all of them were obstructive malformations, the incidence rate was 21. 1, the average age was 15. 0 卤0. 7 years old, and the average age of patients without genital tract malformation was 17. 9 卤0. 5 years old. There was a significant difference between the two groups (P 0. 05, P < 0. 05, P < 0. 05, P < 0. 05). In pubertal endometriosis complicated with reproductive tract malformation, 80. 3% of them had progressive aggravation of dysmenorrhea or periodic lower abdominal pain with primary amenorrhea. The coincidence rate of preoperative diagnosis of genital tract malformation with pelvic color Doppler ultrasound was 80 and MRI was 90. 4. The incidence of genitourinary malformation was 66.7%, in which residual horn uterus and vaginal obliquity were all associated with ipsilateral renal deficiency. The incidence of ovarian lesions in endometriosis was 73.3%. The incidence of r-AFS in moderate and severe stage (鈪，

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