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目的探讨青春期子宫内膜异位症(endometriosis,EMs)合并生殖道畸形的临床特点、诊断及治疗。方法 2010年1月至2016年8月郑州大学第一附属医院手术确诊的青春期EMs患者71例,其中合并生殖道畸形15例,对其临床资料进行回顾性分析。结果 71例青春期EMs中合并生殖道畸形15例(21.1%),均为梗阻性畸形,与无畸形者相比,其就诊年龄较小(P<0.05)。就诊时主要症状是痛经进行性加重或周期性腹痛伴原发性闭经(80%)。盆腔超声术前诊断与手术诊断相符率达80%,核磁共振达90%,合并泌尿系统畸形8例。内异症病变部位以卵巢为多见(73.3%),根据r-AFS标准分期:Ⅱ期6例,Ⅲ期5例,Ⅳ期4例。所有患者均行腹腔镜手术清除盆腔子宫内膜异位病灶,联合宫腔镜或阴式手术解除生殖道梗阻,随访13例,腹痛症状缓解12例,复发1例。结论青春期EMs合并生殖道畸形常见症状为痛经进行性加重、周期性腹痛伴原发性闭经,常合并泌尿系统畸形,盆腔彩超及核磁共振有助于诊断,及时手术解除梗阻预后良好。
Objective To investigate the clinical features, diagnosis and treatment of adolescent endometriosis (EMs) complicated with genital tract deformity. Methods From January 2010 to August 2016, 71 cases of adolescent EMs surgically diagnosed in the First Affiliated Hospital of Zhengzhou University were enrolled. Among them, 15 cases were complicated with genital tract deformity, and their clinical data were retrospectively analyzed. Results 71 cases of adolescent combined with genital tract deformities in 15 cases (21.1%) were obstructive deformities, and their age at diagnosis was lower than those without malformations (P <0.05). The main symptom at treatment is dysmenorrhea with progressive aggravating or recurrent abdominal pain with primary amenorrhea (80%). Pelvic ultrasound preoperative diagnosis and surgical diagnosis of 80% compliance, nuclear magnetic resonance 90%, combined with urinary tract malformations in 8 cases. Endometriosis lesions are more common in ovary (73.3%), according to r-AFS standard staging: 6 cases in stage II, 5 cases in stage III and 4 cases in stage IV. All patients underwent laparoscopic surgery to remove pelvic endometriosis lesions, combined with hysteroscopy or vaginal surgery to relieve the obstruction of the genital tract, followed up for 13 cases, 12 cases of abdominal pain relief, recurrence in 1 case. Conclusions The common symptoms of adolescent EMs with genital tract deformity are progressive dysmenorrhea. Cyclical abdominal pain accompanied by primary amenorrhea, often associated with urinary system malformations, pelvic ultrasound and MRI can be helpful to diagnose the prognosis.