生殖道畸形并发子宫内膜异位症31例临床分析

发布时间：2018-07-18 12:47

【摘要】：目的: 女性先天性生殖道畸形的发病率约0.13%～0.98%，，其中部分生殖道畸形的患者由于经期时子宫内膜腺上皮和间质细胞随经血逆流，经输卵管进入盆腔，种植于卵巢和邻近的盆腔腹膜，并在该处继续生长、蔓延，形成盆腔子宫内膜异位症。生殖道畸形并发子宫内膜异位症的患者有下腹痛、月经流出不畅、性生活困难、不孕等症状，严重影响妇女生活质量。本研究通过总结生殖道畸形并发子宫内膜异位症的病例资料，探讨生殖道畸形与子宫内膜异位症之间的联系，为临床上减少或预防子宫内膜异位症的发生提供参考。方法: 回顾性分析2003年10月～2013年10月山西医科大学第二临床医学院妇产科收治的215例生殖道畸形患者的临床资料，其中并发子宫内膜异位症的31例，均经手术及病理检查确诊。采用SPSS17.0统计软件分析，计量资料比较采用t检验、计数资料采用X2检验及Fisher精确概率法，检验标准α=0.05。结果: （1）215例生殖道畸形患者中，31例并发子宫内膜异位症，占31/215；32例梗阻型生殖道畸形患者中，10例并发子宫内膜异位症，占：10/32，183例非梗阻型生殖道患者中，21例并发子宫内膜异位症，占：21/183，梗阻型生殖道畸形和非梗阻型生殖道畸形并发子宫内膜异位症所占的比例，两者相比，差异有统计学意义（P＜0.05）。（2）生殖道畸形并发子宫内膜异位症患者的年龄及临床症状：梗阻型生殖道畸形并发子宫内膜异位症患者的平均年龄为26岁（15-39岁），非梗阻型生殖道畸形并发子宫内膜异位症患者的平均年龄为37岁（24-54岁），两组比较，差异有统计学意义(P0.05)。梗阻型生殖道畸形并发子宫内膜异位症患者的主要症状为痛经或慢性下腹痛（7/10）和原发性闭经（2/10）；而非梗阻型生殖道畸形并发子宫内膜异位症患者的主要症状为不孕（9/21）、痛经或慢性盆腔痛（8/21）和自然流产（5/21）。（3）生殖道畸形并发子宫内膜异位症的期别：梗阻型生殖道畸形并发子宫内膜异位症的患者中，轻度子宫内膜异位症7例（7/10），中重度子宫内膜异位症3例（3/10），非梗阻型生殖道畸形并发子宫内膜异位症的患者中，轻度子宫内膜异位症9例（9/21），中重度子宫内膜异位症12例（12/21），两组比较均无显著性差异（P＞0.05）。（4）生殖道畸形并发子宫内膜异位症的类型：腹膜型子宫内膜异位症（梗阻型生殖道畸形7/10，非梗阻型生殖道畸形14/21），卵巢型子宫内膜异位症（梗阻型生殖道畸形3/10，非梗阻型生殖道畸形9/21），腹膜型、卵巢型子宫内膜异位症所占的比例在两组间比较，差异均无统计学意义(P0．05)。（5）不同类型的非梗阻型生殖道畸形中子宫内膜异位症所占的比例：双子宫、双角子宫、中隔子宫并发子宫内膜异位症的所占比例分别为（2/8、1/2、16/116），三者中子宫内膜异位症所占的比例比较，差异均无统计学意义(P0．05)。结论: 1.梗阻型生殖道畸形患者并发子宫内膜异位症所占的比例较非梗阻型生殖道畸形患者并发子宫内膜异位症所占的比例增高。2.梗阻型生殖道畸形并发子宫内膜异位症的患者大多数较年轻，主要症状为痛经或慢性下腹痛和原发性闭经，非梗阻型畸形组并发子宫内膜异位症的患者均为育龄期妇女，主要症状为不孕、痛经或慢性盆腔痛和自然流产。3.梗阻型生殖道畸形与非梗阻型生殖道畸形患者中，就诊时子宫内膜异位症的期别无明显差别。4.梗阻型生殖道畸形与非梗阻型生殖道畸形患者中，子宫内膜异位症的类型无明显差别。5.不同类型的非梗阻型生殖道畸形，双子宫、双角子宫、中隔子宫患者中，并发子宫内膜异位症所占的比例中无明显差异。
[Abstract]:Objective:
The incidence of congenital malformation of female genital tract is about 0.13% to 0.98%. In some cases, the patients with some genital deformities are developed in the ovary and the adjacent pelvic peritoneum through the oviduct and the pelvic peritoneum in the ovary and the adjacent pelvic peritoneum due to the menstrual flow and the adenocarcinoma of the endometrium and the interstitial cells. The patients with congenital malformation of the disease complicated with endometriosis have abdominal pain, poor menstrual flow, difficulty in sexual life, and infertility, which seriously affect the quality of life of women. This study summarized the cases of genital malformation complicated with endometriosis, and discussed the relationship between the malformation of the genital tract and endometriosis, and the reduction of the relationship between the disease and the endometriosis. Or to prevent the occurrence of endometriosis.
Method:
The clinical data of 215 cases of reproductive tract malformation admitted in second clinical medicine and obstetrics department of Shanxi Medical University from October 2003 to October 2013 were analyzed retrospectively. Among them, 31 cases of endometriosis complicated by surgery and pathology were all confirmed. SPSS17.0 statistical software was used to analyze the data and the data were compared with t test. Test the standard alpha =0.05. with X2 test and Fisher exact probability method.
Result:
(1) of the 215 cases of reproductive malformation, 31 cases were complicated with endometriosis, accounting for 31/215; of the 32 cases of obstructive reproductive tract malformation, 10 cases were complicated with endometriosis, and 21 cases of endometriosis in non obstructive reproductive tract patients, including 21/183, obstructive reproductive malformation and non obstructive reproductive tract Teratosis. The proportion of concurrency endometriosis was statistically significant (P < 0.05). (2) the age and clinical symptoms of endometriosis patients with reproductive malformation and endometriosis: the average age of the patients with obstructive reproductive tract malformation complicated with endometriosis was 26 years (15-39 years old), and the non obstructive reproductive malformation and the birth of the endometriosis The average age of the patients with endometriosis was 37 years (24-54 years). The difference between the two groups was statistically significant (P0.05). The main symptoms of the obstructive reproductive tract malformation complicated with endometriosis were dysmenorrhea or chronic lower abdominal pain (7/10) and primary amenorrhea (2/10), but the non obstructive reproductive malformation complicated with endometriosis patients. The main symptoms were infertility (9/21), dysmenorrhea or chronic pelvic pain (8/21) and spontaneous abortion (5/21). (3) the reproductive tract malformation complicated with endometriosis: among the patients with obstructive reproductive malformation complicated with endometriosis, 7 cases of mild endometriosis (7/10), 3 cases of moderate to severe endometriosis (3/10), and non obstructive type There were 9 cases of mild endometriosis (9/21), 12 cases of moderate to severe endometriosis (12/21), and no significant difference between the two groups (P > 0.05). (4) the type of reproductive tract malformation complicated with endometriosis: peritoneum endometriosis (obstructive type of genital malformation 7/10, non) Obstructive reproductive tract malformation 14/21), ovarian endometriosis (obstructive type of reproductive tract malformation 3/10, non obstructive 9/21), peritoneal and ovarian endometriosis were compared between the two groups, the difference was not statistically significant (P0.05). (5) endometriosis in different types of non obstructive reproductive tract malformation The proportion of the uterus, the double horns, the uterus and the endometriosis in the septum were respectively (2/8,1/2,16/116). There was no significant difference in the proportion of endometriosis in the three cases, the difference was not statistically significant (P0.05).
Conclusion:
1. the proportion of endometriosis in patients with obstructive reproductive tract malformation is higher than that in patients with non obstructive reproductive malformation associated with endometriosis. Most of the patients with.2. obstructive reproductive tract malformation complicated with endometriosis are younger. The main symptoms are dysmenorrhea or chronic lower abdominal pain and primary amenorrhea. The patients with endometriosis in the non obstructive deformity group are all women of childbearing age. The main symptoms are infertility, dysmenorrhea or chronic pelvic pain and spontaneous abortion.3. obstructive reproductive malformation and non obstructive reproductive tract malformation. There is no significant difference in the stage of endometriosis in.4.. Among the patients with obstructive reproductive tract malformation, the type of endometriosis has no significant difference in.5. different types of non obstructive reproductive tract malformation, and there is no significant difference in the proportion of endometriosis in the double uterus, the double horned uterus and the septum uterus.
【学位授予单位】：山西医科大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R711.1;R711.71

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