【摘要】：目的: 女性先天性生殖道畸形的發(fā)病率約0.13%～0.98%，，其中部分生殖道畸形的患者由于經(jīng)期時子宮內(nèi)膜腺上皮和間質(zhì)細胞隨經(jīng)血逆流，經(jīng)輸卵管進入盆腔，種植于卵巢和鄰近的盆腔腹膜，并在該處繼續(xù)生長、蔓延，形成盆腔子宮內(nèi)膜異位癥。生殖道畸形并發(fā)子宮內(nèi)膜異位癥的患者有下腹痛、月經(jīng)流出不暢、性生活困難、不孕等癥狀，嚴重影響婦女生活質(zhì)量。本研究通過總結生殖道畸形并發(fā)子宮內(nèi)膜異位癥的病例資料，探討生殖道畸形與子宮內(nèi)膜異位癥之間的聯(lián)系，為臨床上減少或預防子宮內(nèi)膜異位癥的發(fā)生提供參考。 方法: 回顧性分析2003年10月～2013年10月山西醫(yī)科大學第二臨床醫(yī)學院婦產(chǎn)科收治的215例生殖道畸形患者的臨床資料，其中并發(fā)子宮內(nèi)膜異位癥的31例，均經(jīng)手術及病理檢查確診。采用SPSS17.0統(tǒng)計軟件分析，計量資料比較采用t檢驗、計數(shù)資料采用X2檢驗及Fisher精確概率法，檢驗標準α=0.05。 結果: （1）215例生殖道畸形患者中，31例并發(fā)子宮內(nèi)膜異位癥，占31/215；32例梗阻型生殖道畸形患者中，10例并發(fā)子宮內(nèi)膜異位癥，占：10/32，183例非梗阻型生殖道患者中，21例并發(fā)子宮內(nèi)膜異位癥，占：21/183，梗阻型生殖道畸形和非梗阻型生殖道畸形并發(fā)子宮內(nèi)膜異位癥所占的比例，兩者相比，差異有統(tǒng)計學意義（P＜0.05）。（2）生殖道畸形并發(fā)子宮內(nèi)膜異位癥患者的年齡及臨床癥狀：梗阻型生殖道畸形并發(fā)子宮內(nèi)膜異位癥患者的平均年齡為26歲（15-39歲），非梗阻型生殖道畸形并發(fā)子宮內(nèi)膜異位癥患者的平均年齡為37歲（24-54歲），兩組比較，差異有統(tǒng)計學意義(P0.05)。梗阻型生殖道畸形并發(fā)子宮內(nèi)膜異位癥患者的主要癥狀為痛經(jīng)或慢性下腹痛（7/10）和原發(fā)性閉經(jīng)（2/10）；而非梗阻型生殖道畸形并發(fā)子宮內(nèi)膜異位癥患者的主要癥狀為不孕（9/21）、痛經(jīng)或慢性盆腔痛（8/21）和自然流產(chǎn)（5/21）。（3）生殖道畸形并發(fā)子宮內(nèi)膜異位癥的期別：梗阻型生殖道畸形并發(fā)子宮內(nèi)膜異位癥的患者中，輕度子宮內(nèi)膜異位癥7例（7/10），中重度子宮內(nèi)膜異位癥3例（3/10），非梗阻型生殖道畸形并發(fā)子宮內(nèi)膜異位癥的患者中，輕度子宮內(nèi)膜異位癥9例（9/21），中重度子宮內(nèi)膜異位癥12例（12/21），兩組比較均無顯著性差異（P＞0.05）。（4）生殖道畸形并發(fā)子宮內(nèi)膜異位癥的類型：腹膜型子宮內(nèi)膜異位癥（梗阻型生殖道畸形7/10，非梗阻型生殖道畸形14/21），卵巢型子宮內(nèi)膜異位癥（梗阻型生殖道畸形3/10，非梗阻型生殖道畸形9/21），腹膜型、卵巢型子宮內(nèi)膜異位癥所占的比例在兩組間比較，差異均無統(tǒng)計學意義(P0．05)。（5）不同類型的非梗阻型生殖道畸形中子宮內(nèi)膜異位癥所占的比例：雙子宮、雙角子宮、中隔子宮并發(fā)子宮內(nèi)膜異位癥的所占比例分別為（2/8、1/2、16/116），三者中子宮內(nèi)膜異位癥所占的比例比較，差異均無統(tǒng)計學意義(P0．05)。 結論: 1.梗阻型生殖道畸形患者并發(fā)子宮內(nèi)膜異位癥所占的比例較非梗阻型生殖道畸形患者并發(fā)子宮內(nèi)膜異位癥所占的比例增高。2.梗阻型生殖道畸形并發(fā)子宮內(nèi)膜異位癥的患者大多數(shù)較年輕，主要癥狀為痛經(jīng)或慢性下腹痛和原發(fā)性閉經(jīng)，非梗阻型畸形組并發(fā)子宮內(nèi)膜異位癥的患者均為育齡期婦女，主要癥狀為不孕、痛經(jīng)或慢性盆腔痛和自然流產(chǎn)。3.梗阻型生殖道畸形與非梗阻型生殖道畸形患者中，就診時子宮內(nèi)膜異位癥的期別無明顯差別。4.梗阻型生殖道畸形與非梗阻型生殖道畸形患者中，子宮內(nèi)膜異位癥的類型無明顯差別。5.不同類型的非梗阻型生殖道畸形，雙子宮、雙角子宮、中隔子宮患者中，并發(fā)子宮內(nèi)膜異位癥所占的比例中無明顯差異。
[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.
【學位授予單位】：山西醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2014
【分類號】：R711.1;R711.71

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