本文選題：青春期 + 子宮內(nèi)膜異位癥��； 參考：《鄭州大學》2017年碩士論文

【摘要】：背景子宮內(nèi)膜異位癥(endometriosis,EMs,簡稱內(nèi)異癥)是育齡期婦女常見疾病,主要以盆腔包塊、下腹痛與痛經(jīng)、不孕為表現(xiàn),是一種嚴重影響女性卵巢儲備功能及生育能力的疾病。青春期(世界衛(wèi)生組織,world health organization,WHO對青春期界定是10~19歲)子宮內(nèi)膜異位癥發(fā)病率逐年增加,亦有相關(guān)文獻報道其發(fā)病率并不低于育齡期。異位子宮內(nèi)膜來源尚未闡明,被國內(nèi)外學者公認的學說是Sampson提出的“經(jīng)血逆流學說”。據(jù)此學說推論,生殖道梗阻畸形應(yīng)是內(nèi)異癥發(fā)病的高危因素。生殖道畸形不同類型臨床表現(xiàn)不一,比較復雜,給診斷和治療帶來一定難度,且由于青春期年齡、心理等的特殊性,疾病往往延誤診治。目的探討青春期子宮內(nèi)膜異位癥合并生殖道畸形的臨床特點、診斷及治療,以期為疾病早期診斷、早期治療提供參考。方法收集2012年7月~2015年12月間經(jīng)我院婦科確診的青春期子宮內(nèi)膜異位癥71例患者的臨床資料,其中合并生殖道畸形15例,對其臨床資料進行回顧性分析,選取患者的發(fā)病年齡、初潮年齡、月經(jīng)情況、臨床特征、盆腔及泌尿系彩超檢查、核磁共振成像(Magnetic Resonance Imaging,MRI)檢查、血清糖類抗原125(carbohydrate antigen 125,CA125)、手術(shù)方式及術(shù)中情況等作為主要觀察指標。術(shù)后病人定期隨訪,隨訪結(jié)果專人記錄。女性的生殖道畸形分類依據(jù)中華婦產(chǎn)科學(第3版)進行,內(nèi)異癥分期根據(jù)1985年美國生育協(xié)會修訂的內(nèi)異癥分期標準(Revised American Fertility Society,r-AFS)進行。臨床數(shù)據(jù)采用SPSS21.0軟件進行統(tǒng)計學分析,計量資料用(?)±s表示,采用t檢驗。結(jié)果1.71例青春期子宮內(nèi)膜異位癥中合并生殖道畸形15例,均為梗阻性畸形,發(fā)生率21.1%,其平均年齡15.0±0.7歲,未合并生殖道畸形者平均發(fā)病年齡17.9±0.5歲,兩者比較差異有統(tǒng)計學意義(P0.05)。2.青春期子宮內(nèi)膜異位癥合并生殖道畸形者中因痛經(jīng)進行性加重或周期性下腹痛伴原發(fā)性閉經(jīng)就診者占80%。3.盆腔彩超術(shù)前診斷生殖道畸形與手術(shù)相符率達80%,MRI達90%。4.生殖道畸形中合并泌尿系畸形發(fā)生率66.7%,其中殘角子宮及陰道斜隔患者均合并同側(cè)腎缺如。5.內(nèi)異癥病變部位卵巢發(fā)生率達73.3%,r-AFS分期以中重度(Ⅲ、Ⅳ期)多見60%。6.所有患者行腹腔鏡手術(shù)清除盆腔子宮內(nèi)膜異位病灶,聯(lián)合宮腔鏡或陰式手術(shù)解除生殖道梗阻,隨訪13例,腹痛癥狀緩解率92.3%,復發(fā)率低7.7%結(jié)論1.青春期子宮內(nèi)膜異位癥合并生殖道畸形常見癥狀為痛經(jīng)進行性加重或周期性腹痛伴原發(fā)性閉經(jīng)。盆腔彩超及MRI有助于診斷,及時手術(shù)解除梗阻預后良好。2.生殖道畸形常合并泌尿系畸形,對意外發(fā)現(xiàn)的泌尿系畸形患者應(yīng)行盆腔彩超,以早期發(fā)現(xiàn)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 鹵0. 7 years old, and the average age of patients without genital tract malformation was 17. 9 鹵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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