[1]王欣 金佟 郭银树*.子宫非典型息肉样腺肌瘤49例临床分析[J].中国微创外科杂志,2020,01(10):887-890.
　Wang Xin,Jin Tong,Guo Yinshu..Clinical Analysis of 49 Cases of Atypical Polypoid Adenomyoma of the Uterus[J].Chinese Journal of Minimally Invasive Surgery,2020,01(10):887-890.
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子宫非典型息肉样腺肌瘤49例临床分析()
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《中国微创外科杂志》[ISSN:1009-6604/CN:11-4526/R]

卷:
01
期数:
2020年10期
页码:
887-890
栏目:
临床研究
出版日期:
2020-10-25

文章信息/Info

Title:
Clinical Analysis of 49 Cases of Atypical Polypoid Adenomyoma of the Uterus
作者:
王欣 金佟 郭银树*
(首都医科大学附属北京妇产医院妇科微创中心，北京100006)
Author(s):
Wang Xin;  Jin Tong;  Guo Yinshu.
Gynecological Minimally Invasive Center, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing 100006, China
关键词:
非典型息肉样腺肌瘤; 宫腔镜
Keywords:
Atypical polypoid adenomyoma; Hysteroscopy
文献标志码:
A
摘要:
目的探讨子宫非典型息肉样腺肌瘤(atypical polypoid adenomyoma, APA) 的临床特点及诊治。方法2005年6月~2019年9月我们采用宫腔镜“四步诊疗法”治疗APA 49例，即完整切除占位病变，切除根蒂部周围0.2～0.5 cm内膜，切除根蒂下方约0.3 cm子宫肌层，活检宫腔其余部位内膜。结果宫腔镜检查单发病灶45例(病变直径0.5～6 cm，平均2.0 cm)，多发病灶4例。术后病理诊断均为APA。术后保守治疗32例：高度结构异型指数APA (a high architecture index APA，APAH) 4例、低度结构异型指数APA (a low architecture index APA，APAL)合并子宫内膜轻度非典型增生2例口服高效孕激素治疗；APAL 26例，其中口服高效孕激素治疗8例，月经后半周期口服孕激素治疗9例，口服短效避孕药治疗4例，未药物治疗定期随访5例。手术治疗17例：1例行宫腔镜子宫内膜切除术，16例行全子宫+双输卵管/附件切除术。49例术后随访3~174个月，中位数35.0月，接受保守治疗患者均无复发，手术患者术后随访无异常。结论对直径＞1 cm的宫腔内占位病变，宫腔镜“四步诊疗法”及术后病理结果是制定临床治疗方案的基础。APA表面腺体组织含分支及出芽等复杂结构腺体成分≥30%或合并子宫内膜病变等其他高危因素应行子宫切除术，如果患者有生育要求或保留子宫愿望，宫腔镜完整切除病灶后根据病理结果、有无生育要求进行个体化治疗，定期宫腔镜检查及子宫内膜活检进行随访，临床预后良好。
Abstract:
ObjectiveTo analyze the clinical characteristics, diagnosis and prognosis of atypical polypoid adenomyoma (APA) of the uterus.MethodsFortynine patients with APA were admitted to our hospital from June 2005 to September 2019, whose clinical and histopathologic features were evaluated. All the cases received hysteroscopic “fourstep diagnosis and treatment”: complete excision of uterine space occupying lesion; excision of 0.2-0.5 cm endometrium around the pedicle; excision of 0.3 cm myometrium below the pedicle; biopsy of the rest of uterine cavity.ResultsThe single lesion was found in 45 cases (918%) and the mean size was 2.0 cm (range, 0.5-6 cm). Multiple lesions were found in 4 cases. APA was diagnosed pathologically after hysteroscopic resection of the lesion. A total of 32 cases were treated conservatively, including 4 cases of APAH (a high architecture index APA) and 2 cases of APAL (a low architecture index APA) combined with mild atypical hyperplasia of endometrium, who were treated with medroxyprogesterone acetate, as well as 26 cases with APAL (8 cases were treated with medroxyprogesterone acetate, 9 cases were treated with progestin in the second half cycle of menstruation, 4 cases were treated with shortacting oral contraceptive and five cases were followed up regularly without medication). Operation was performed in 17 cases. One case underwent transcervical endometrium resection. Total hysterectomy and salpingectomy/salpingooophorectomy was performed in the other 16 cases. Followups for 3-174 months (median, 35.0 months) were available in 49 patients. No recurrence was found in all the patients receiving conservative treatment, and no abnormality was found in postoperative followups.ConclusionsFor patients with intracavitary lesion > 1 cm, hysteroscopic “fourstep diagnosis and treatment” and pathological diagnosis are the basis of clinical treatment. APA surface glands containing more than 30% of the complex structures of glands such as branching and budding, or other high risk factors such as endometrial hyhperplasia are indications for hysterectomy. For the patients with desires to get pregnancy or to keep the uterus, hysteroscopy with complete excision of the lesions should be a preferred treatment method. The patients should be treated individualized and given close followups. The patients should be followed up by regular hysteroscopy and endometrial biopsy.

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备注/Memo

备注/Memo:
*通讯作者，Email：15110237828@163.com
更新日期/Last Update: 2021-01-13