青少年型囊性子宫腺肌病一例并文献复习

doi:10.12280/gjszjk.20220200

摘要/Abstract

摘要：

青少年型囊性子宫腺肌病（juvenile cystic adenomyosis ）是子宫腺肌病的罕见分型,主要表现为初潮5年内出现严重盆腔疼痛及痛经,药物治疗效果不佳。盆腔磁共振成像是最敏感的检查,术前与梗阻性生殖道畸形难以鉴别。腹腔镜切除病灶是本病最确切的治疗方式,术后复发率低。报告1例青少年型囊性子宫腺肌病病例,患者初潮后2年痛经剧烈,术前被误诊为梗阻性生殖道畸形,腹腔镜探查术中诊断为囊性子宫腺肌病,完整切除病灶后痛经症状明显改善。通过回顾相关文献,加深对青少年型囊性子宫腺肌病的认识。

关键词: 子宫腺肌病, 青少年, 痛经, 青少年型囊性子宫腺肌病, 治疗, 病例报告

Abstract:

Juvenile cystic adenomyosis, a rare type of adenomyosis, is mainly manifested as the severe pelvic pain and dysmenorrhea within 5 years of menarche, and the inefficiency of drug treatment. Pelvic MRI is the most sensitive examination. It was difficult to distinguish the juvenile cystic adenomyosis from the obstructive uterine and vaginal dysplasia before sugury. Laparoscopic resection of lesions is the most accurate treatment for this disease, with a low postoperative recurrence rate. A case of juvenile cystic adenomyosis was reported in this paper. The patient had severe dysmenorrhea over 2 years after menarche. The case was misdiagnosed as obstructive reproductive tract malformation before surgery. Cystic adenomyosis was diagnosed during laparoscopic exploration. The dysmenorrhea symptoms were significantly improved after complete resection of the lesion. This case report combined with literature review is helpful for us to deepen the understanding of juvenile cystic adenomyosis.

Key words: Adenomyosis, Adolescent, Dysmenorrhea, Juvenile cystic adenomyosis, Therapy, Case reports

马薇薇, 邢莹, 丁易钤. 青少年型囊性子宫腺肌病一例并文献复习[J]. 国际生殖健康/计划生育, 2022, 41(5): 400-403.

MA Wei-wei, XING Ying, DING Yi-qian. Juvenile Cystic Adenomyosis: A Case Report and Literature Review[J]. Journal of International Reproductive Health/Family Planning, 2022, 41(5): 400-403.

图/表 1

参考文献 22

[1]	Zhao CZ, Wang B, Zhong CY, et al. Management of uterine cystic adenomyosis by laparoscopic surgery: case report[J]. BMC Womens Health, 2021, 21(1):263. doi: 10.1186/s12905-021-01341-1. doi: 10.1186/s12905-021-01341-1 URL
[2]	刘秀, 刘海元, 史宏晖, 等. 囊性子宫腺肌病的研究和诊治进展[J]. 生殖医学杂志, 2015, 24(10):873-876. doi: 10.3969/j.issn.1004-3845.2015.10.024. doi: 10.3969/j.issn.1004-3845.2015.10.024
[3]	Parulekar SV. Cystic degeneration in an adenomyoma (a case report)[J]. J Postgrad Med, 1990, 36(1):46-47. pmid: 2097356
[4]	Tamura M, Fukaya T, Takaya R, et al. Juvenile adenomyotic cyst of the corpus uteri with dysmenorrhea[J]. Tohoku J Exp Med, 1996, 178(3):339-344. doi: 10.1620/tjem.178.339. doi: 10.1620/tjem.178.339 pmid: 8727716
[5]	Martin DC, Koninckx PR. Juvenile cystic adenomyomas: acquired adenomyosis variant or congenital Müllerian defects?[J]. F S Rep, 2021, 2(2):145. doi: 10.1016/j.xfre.2021.04.004.eCollection2021Jun. doi: 10.1016/j.xfre.2021.04.004.eCollection2021Jun.
[6]	中国医师协会妇产科医师分会子宫内膜异位症专业委员会. 子宫腺肌症诊治中国专家共识[J]. 中华妇产科杂志, 2020, 55(6):376-383. doi: 10.3760/cma.j.cn112141-20200228-00150. doi: 10.3760/cma.j.cn112141-20200228-00150
[7]	Wang JH, Wu RJ, Xu KH, et al. Single large cystic adenomyoma of the uterus after cornual pregnancy and curettage[J]. Fertil Steril, 2007, 88(4):965-967. doi: 10.1016/j.fertnstert.2006.12.085. doi: 10.1016/j.fertnstert.2006.12.085 URL
[8]	Takeuchi H, Kitade M, Kikuchi I, et al. Diagnosis, laparoscopic management, and histopathologic findings of juvenile cystic adenomyoma: a review of nine cases[J]. Fertil Steril, 2010, 94(3):862-868. doi: 10.1016/j.fertnstert.2009.05.010. doi: 10.1016/j.fertnstert.2009.05.010 pmid: 19539912
[9]	Koukoura O, Kapsalaki E, Daponte A, et al. Laparoscopic treatment of a large uterine cystic adenomyosis in a young patient[J]. BMJ Case Rep, 2015 Oct 1. doi: 10.1136/bcr-2015-210358. doi: 10.1136/bcr-2015-210358
[10]	Fisseha S, Smith YR, Kumetz LM, et al. Cystic myometrial lesion in the uterus of an adolescent girl[J]. Fertil Steril, 2006, 86(3):716-718. doi: 10.1016/j.fertnstert.2006.03.019. doi: 10.1016/j.fertnstert.2006.03.019 pmid: 16828476
[11]	McWilliams MM, Chennathukuzhi VM. Recent Advances in Uterine Fibroid Etiology[J]. Semin Reprod Med, 2017, 35(2):181-189. doi: 10.1055/s-0037-1599090. doi: 10.1055/s-0037-1599090 pmid: 28278535
[12]	Arya S, Burks HR. Juvenile cystic adenomyoma, a rare diagnostic challenge: Case Reports and literature review[J]. F S Rep, 2021, 2(2):166-171. doi: 10.1016/j.xfre.2021.02.002. doi: 10.1016/j.xfre.2021.02.002
[13]	Brosens I, Gordts S, Habiba M, et al. Uterine Cystic Adenomyosis: A Disease of Younger Women[J]. J Pediatr Adolesc Gynecol, 2015, 28(6):420-426. doi: 10.1016/j.jpag.2014.05.008. doi: 10.1016/j.jpag.2014.05.008 URL
[14]	Lu ST, Zhao CZ, Liu LB. Lesion of cystic adenomyosis in the left uterine cornual wall[J]. Arch Gynecol Obstet, 2021 Oct 25. doi: 10.1007/s00404-021-06301-6. doi: 10.1007/s00404-021-06301-6
[15]	Sun W, Guo X, Zhu L, et al. Hysteroscopic Treatment of a Uterine Cystic Adenomyosis[J]. J Minim Invasive Gynecol, 2018, 25(3):374-375. doi: 10.1016/j.jmig.2017.07.015. doi: 10.1016/j.jmig.2017.07.015 URL
[16]	Zhou Y, Chen ZY, Zhang XM. Giant exophytic cystic adenomyosis with a levonorgestrel containing intrauterine device out of the uterine cavity after uterine myomectomy: A case report[J]. World J Clin Cases, 2020, 8(1):188-193. doi: 10.12998/wjcc.v8.i1.188. doi: 10.12998/wjcc.v8.i1.188 pmid: 31970186
[17]	Said MR faneh HA, Zaghmout O, et al. Minimally invasive management of juvenile cystic adenomyoma: report of three cases[J]. Facts Views Vis Obgyn, 2021, 13(3):267-272. doi: 10.52054/FVVO.13.3.033. doi: 10.52054/FVVO.13.3.033 URL
[18]	Deblaere L, Froyman W, Van den Bosch T, et al. Juvenile cystic adenomyosis: A case report and review of the literature[J]. Australas J Ultrasound Med, 2019, 22(4):295-300. doi: 10.1002/ajum.12171. doi: 10.1002/ajum.12171 URL
[19]	Kumar A. Myometrial cyst[J]. J Minim Invasive Gynecol, 2007, 14(4):395-396. doi: 10.1016/j.jmig.2006.12.009. doi: 10.1016/j.jmig.2006.12.009 URL
[20]	Giana M, Montella F, Surico D, et al. Large intramyometrial cystic adenomyosis: a hysteroscopic approach with bipolar resectoscope: case report[J]. Eur J Gynaecol Oncol, 2005, 26(4):462-463. pmid: 16122206
[21]	Jain N, Goel S. Cystic Adenomyoma simulates uterine malformation: A diagnostic dilemma: Case report of two unusual cases[J]. J Hum Reprod Sci, 2012, 5(3):285-288. doi: 10.4103/0974-1208.106342. doi: 10.4103/0974-1208.106342 pmid: 23532253
[22]	Cucinella G, Billone V, Pitruzzella I, et al. Adenomyotic cyst in a 25-year-old woman: case report[J]. J Minim Invasive Gynecol, 2013, 20(6):894-898. doi: 10.1016/j.jmig.2013.04.022. doi: 10.1016/j.jmig.2013.04.022 URL