子宫腺肌病的临床表现

doi:10.6040/j.issn.1671-7554.0.2022.0433

摘要/Abstract

摘要： 子宫腺肌病是育龄期妇女的常见疾病,发病率逐年上升但发病机制不清,流行病学调查受诊断标准的影响存在一定偏倚。其临床表现多样,包括痛经进行性加重、异常子宫出血和不孕,并与多种不良妊娠结局相关,影响女性生殖健康及家庭关系。此外,腺肌病可合并多种激素依赖性疾病,其中同时合并内异症者疼痛更加严重并多样化,妊娠结局更差,临床表现更为复杂。

关键词: 子宫腺肌病, 流行病学, 子宫内膜异位症, 疼痛, 不孕

Abstract: Adenomyosis is a common disease among women of childbearing age. The incidence rate is increasing while the pathogenesis is still unclear. Epidemiological investigation is biased by diagnostic criteria. The clinical manifestations are diverse, including progressive dysmenorrhea, abnormal uterine bleeding and infertility. It is also related to a variety of adverse pregnancy outcomes, affecting womens reproductive health and family relationship. In addition, adenomyosis can be complicated with a variety of hormone-dependent diseases, especially endometriosis. In such cases, the pain symptoms are more severe and diverse, and the pregnancy outcomes are poorer, further complicating the clinical manifestations.

Key words: Adenomyosis, Epidemiology, Endometriosis, Pain, Infertility

中图分类号:

R711.74

冷金花, 史精华. 子宫腺肌病的临床表现[J]. 山东大学学报 (医学版), 2022, 60(7): 1-5.

LENG Jinhua, SHI Jinghua. Clinical manifestations of adenomyosis[J]. Journal of Shandong University (Health Sciences), 2022, 60(7): 1-5.

参考文献

[1] Upson K, Missmer SA. Epidemiology of adenomyosis [J]. Semin Reprod Med, 2020, 38(2-3): 89-107.
[2] Naftalin J, Hoo W, Pateman K, et al. How common is adenomyosis? a prospective study of prevalence using transvaginal ultrasound in a gynaecology clinic [J]. Hum Reprod, 2012, 27(12): 3432-3439.
[3] Naftalin J, Hoo W, Nunes N, et al. Association between ultrasound features of adenomyosis and severity of menstrual pain [J]. Ultrasound Obstet Gynecol, 2016, 47(6): 779-783.
[4] Pinzauti S, Lazzeri L, Tosti C, et al. Transvaginal sonographic features of diffuse adenomyosis in 18-30-year-old nulligravid women without endometriosis: association with symptoms [J]. Ultrasound Obstet Gynecol, 2015, 46(6): 730-736.
[5] Kho KA, Chen JS, Halvorson LM. Diagnosis, evaluation, and treatment of adenomyosis [J]. Jama, 2021, 326(2): 177-178.
[6] Xue M, Leng J, Wong F. Adenomyosis: facts and treatments [M]. Singapore: Springer Singapore, 2021.
[7] Parazzini F, Vercellini P, Panazza S, et al. Risk factors for adenomyosis [J]. Human Reprod, 1997, 12(6): 1275-1279.
[8] Shrestha A. Risk factors for adenomyosis [J]. J Nepal Health Res Counc, 2012, 10(22): 229-233.
[9] Jean-Baptiste H, Tetrokalashvili M, Williams T, et al. Characteristics associated with postoperative diagnosis of adenomyosis or combined adenomyosis with fibroids [J]. Int J Gynaecol Obstet, 2013, 122(2): 112-114.
[10] 李雁, 张绍芬, 夏贤, 等. 口服他莫昔芬法建立ICR小鼠子宫腺肌病模型[J]. 中国实验动物学报, 2009, 17(5): 345-350. LI Yan, ZHANG Shaofen, XIA Xian, et al. Establishment of an ICR mouse model of adenomyosis by oral administration of tamoxifen [J]. Acta Laboratorium Animalis Scientia Sinica, 2009, 17(5): 345-350.
[11] Bourdon M, Santulli P, Marcellin L, et al. Adenomyosis: an update regarding its diagnosis and clinical features[J]. J Gynecol Obstet Hum Reprod, 2021, 50(10): 102228.
[12] Pinzauti S, Lazzeri L, Tosti C, et al. Transvaginal sonographic features of diffuse adenomyosis in 18-30-year-old nulligravid women without endometriosis: association with symptoms [J]. Ultrasound Obstet Gynecol, 2015, 46(6): 730-736.
[13] 郎景和. 重视子宫腺肌病的多元化治疗[J]. 中华妇产科杂志, 2016, 51(9): 641-642. LANG Jinghe. Pay attention to the diversified treatment of adenomyosis [J]. Chinese Journal of Obstetrics and Gynecology, 2016, 51(9): 641-642.
[14] Peric H, Fraser IS. The symptomatology of adenomyosis[J]. Best Pract Res Clin Obstet Gynaecol, 2006, 20(4):547-555.
[15] Chapron C, Vannuccini S, Santulli P, et al. Diagnosing adenomyosis: an integrated clinical and imaging approach[J]. Hum Reprod Update, 2020, 26(3):392-411.
[16] Bird CC, McElin TW, Manalo-Estrella P. The elusive adenomyosis of the uterus - revisited [J]. Am J Obstet Gynecol, 1972, 112(5): 583-593.
[17] Nishida M. Relationship between the onset of dysmenorrhea and histologic findings in adenomyosis [J]. Am J Obstet Gynecol, 1991, 165(1): 229-231.
[18] Levgur M, Abadi MA, Tucker A. Adenomyosis: symptoms, histology, and pregnancy terminations [J]. Obstet Gynecol, 2000, 95(5): 688-691.
[19] 王波, 吴明富. 子宫腺肌病导致继发性痛经相关机制的研究进展[J]. 华中科技大学学报(医学版), 2019, 48(1): 113-116. WANG Bo, WU Mingfu.Research progress on the mechanism of secondary dysmenorrhea caused by adenomyosis [J]. Acta Medicinae Universitatis Scientiae et Technologiae Huazhong, 2019, 48(1): 113-116.
[20] 楼俊瑶,黄秀峰,张丽凤,等.第二代子宫内膜消融术可提高左炔诺孕酮宫内节育系统对子宫腺肌病患者的疗效[J]. 浙江大学学报(医学版),2019,48(2):136-141. LOU Junyao, HUANG Xiufeng, ZHANG Lifeng, et al. The second generation endometrial ablation(NovaSure)improves efficacy of levonorgestrel-releasing intrauterine system in management of adenomyosis[J]. Journal of Zhejiang University(Medical Sciences), 2019, 48(2):136-141.
[21] Abbott JA. Adenomyosis and abnormal uterine bleeding(AUB-A)-pathogenesis, diagnosis, and management [J]. Best Pract Res Clin Obstet Gynaecol, 2017, 40: 68-81. doi: 10.1016/j.bpobgyn.2016.09.006.
[22] Harmsen MJ, Wong CFC, Mijatovic V, et al. Role of angiogenesis in adenomyosis-associated abnormal uterine bleeding and subfertility: a systematic review [J]. Human Reprod Update, 2019, 25(5): 647-671.
[23] Bourdon M, Oliveira J, Marcellin L, et al. Adenomyosis of the inner and outer myometrium are associated with different clinical profiles [J]. Hum Reprod, 2021, 36(2): 349-357.
[24] 桂婷, 邓姗, 何永兰, 等. 子宫肌腺症是难治性排卵障碍性异常子宫出血的潜在因素: 病例系列研究[J]. 生殖医学杂志, 2020, 29(7): 932-939. GUI Ting, DENG Shan, HE Yonglan, et al. Involvement of adenomyosis in refractory abnormal uterine bleeding-ovulatory dysfunction: a case series [J]. Journal of Reproductive Medicine, 2020, 29(7): 932-939.
[25] 冷金花, 史精华. 子宫腺肌病合并不孕治疗策略[J].中国实用妇科与产科杂志, 2020, 36(6): 516-519. LENG Jinhua, SHI Jinghua.Management of infertility in women with adenomyosis [J]. Chinese Journal of Practical Gynecology and Obstetrics, 2020, 36(6): 516-519.
[26] Younes G, Tulandi T. Effects of adenomyosis on in vitro fertilization treatment outcomes: a meta-analysis [J]. Fertil Steril, 2017, 108(3): 483-490.
[27] 子宫腺肌病伴不孕症诊疗中国专家共识编写组. 子宫腺肌病伴不孕症诊疗中国专家共识[J]. 中华生殖与避孕杂志, 2021, 41(4): 287-295. Compilation group of Chinese expert consensus on the diagnosis and treatment of adenomyosis with infertility. Chinese experts consensus on diagnosis and clinical management of adenomyosis with infertility [J]. Chinese Journal of Reproduction and Contraception, 2021, 41(4): 287-295.
[28] 陈沫, 江秀秀. 子宫腺肌病与不孕的相关性研究[J]. 国际妇产科学杂志, 2021, 48(6): 646-650. CHEN Mo, JIANG Xiuxiu. Study on the relationship between adenomyosis and infertility [J]. Journal of International Obstetrics And Gynecology, 2021, 48(6): 646-650.
[29] 中华医学会妇产科学分会子宫内膜异位症协作组. 子宫内膜异位症诊治指南(第三版)[J].中华妇产科杂志, 2021, 56(12): 812-824. Endometriosis cooperation group of Chinese society of Obstetrics and Gynecology. Guideline for the diagnosis and treatment of endometriosis(Third edition)[J]. Chinese Journal of Obstetrics and Gynecology, 2021, 56(12): 812-824.
[30] 李雷, 冷金花, 戴毅, 等. 盆腔子宫内膜异位症手术患者不同年龄阶段的特点和趋势[J]. 中国实用妇科与产科杂志, 2011, 27(3): 188-191. LI Lei, LENG Jinhua, DAI Yi, et al. Characteristics and trends of surgical management of pelvic endometriosis in different ages [J]. Chinese Journal of Practical Gynecology and Obstetrics, 2011, 27(3): 188-191.
[31] Chapron C, Tosti C, Marcellin L, et al. Relationship between the magnetic resonance imaging appearance of adenomyosis and endometriosis phenotypes [J]. Hum Reprod, 2017, 32(7): 1393-1401.
[32] Bourdon M, Pham B, Marcellin L, et al. Endometriosis increases the rate of spontaneous early miscarriage in women who have adenomyosis lesions [J]. Reprod Biomed Online, 2022, 44(1): 104-111.
[33] Sun TT, Chen SK, Li XY, et al. Fertility outcomes after laparoscopic cystectomy in infertile patients with stage III-IV endometriosis: a cohort with 6-10 years of follow-up [J]. Adv Ther, 2020, 37(5): 2159-2168.
[34] Shi J, Dai Y, Zhang J, et al. Pregnancy outcomes in women with infertility and coexisting endometriosis and adenomyosis after laparoscopic surgery: a long-term retrospective follow-up study [J]. BMC Pregnancy Childbirth, 2021, 21(1): 383.
[35] 史精华, 张俊吉, 戴毅, 等. 子宫内膜异位症合并子宫腺肌症不孕患者临床手术特点分析[J]. 现代妇产科进展, 2019, 28(6): 434-437. SHI Jinghua, ZHANG Junji, DAI Yi, et al. Characteristics of clinical manifestations and surgical management on infertile women with both endometriosis and adenomyosis [J]. Progress in Obstetrics and Gynecology, 2019, 28(6): 434-437.
[36] 郎景和. 子宫腺肌症的迷惑与解惑[J]. 中华妇产科杂志, 2020, 11(55): 737-739. LANG Jinghe. Confusion and puzzle of adenomyosis [J]. Chinese Journal of Obstetrics and Gynecology, 2020, 11(55): 737-739.

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