摘要
目的分析囊性子宫腺肌病合并严重宫腔粘连误诊为Robert子宫畸形的1例罕见病例,总结分析误诊原因及防范误诊措施。方法回顾性分析2022年2月湖北省妇幼保健院收治的1例囊性子宫腺肌病误诊为Robert子宫畸形病例的临床资料及诊疗过程。结果患者因“药物无法控制的痛经症状”就诊,彩超及子宫附件平扫+增强(MR)均提示Robert子宫畸形。入院后行腹腔镜检+宫腔镜子宫病损电切术,腹腔镜下见宫底横径增宽,右侧宫角饱满,右侧输卵管中远端明显增粗膨大;宫腔镜下等离子双极电刀反复电切纤维肌性状粘连带始终无法暴露右侧宫角及输卵管开口;术后组织学病检示:宫角部病损为增生的子宫内膜及平滑肌组织,结合术中所见、患者手术史及术后病理检查,最终确诊宫角部囊性子宫腺肌病合并宫腔粘连。术后予以3个周期促性腺激素释放激素激动剂(GnRH-a)联合宫内置入曼月乐环进行长期管理。随访6个月,患者预后好,病灶未复发。结论对于难治性痛经,应区分是原发性还是继发性,不能仅依据影像学检查来作出诊断,尤其是在评估患者是否有子宫畸形时,术前系统问诊及完善的辅助检查对于避免不恰当的诊疗尤为重要。
Objective To analyze a rare case of cystic adenomyosis complicated combined with severe intrauterine adhesions misdiagnosed as Robert′s uterine malformation,and to summarize and analyze the causes of misdiagnosis and preventive measures for misdiagnosis.Methods The clinical data,diagnosis and treatment process of a case of cystic adenomyosis misdiagnosed as Robert′s uterine malformation admitted to Hubei Maternal and Child Health Care Hospital in February 2022 were retrospectively analyzed.Results The patient was presented with"medically uncontrollable dysmenorrhea".Color ultrasound and magnetic resonance(MR)with/without contrast of the uterine adnexa showed that Robert′s uterus was malformed.After admission,laparoscopy and hysteroscopic hysterectomy were performed.Under laparoscopy,the transverse diameter of the uterine fundus was widened,the right uterine angle was full,and the right middle and distal fallopian tubes were significantly enlarged.The right uterine horn and fallopian tube opening could not be exposed after repeated electrotomy by plasma bipolar electroknife under hysteroscope.Postoperative histological findings showed that the uterine corner lesions were hyperplasia of endometrium and smooth muscle tissue.Combined with the intraoperative findings,the patient′s surgical history and postoperative pathological examination,the final diagnosis of uterine cornual cystic adenomyosis combined with intrauterine adhesions was confirmed.Three cycles of gonadotropin-releasing hormone agonist(GnRH-a)combined with intrauterine implantation of mirena ring were administered for long-term management.After 6 months of follow-up,the patient had a good prognosis and no recurrence of the lesions.Conclusions For refractory dysmenorrhea,it is necessary to distinguish whether it is primary or secondary,and the diagnosis cannot be made only based on imaging examination.Especially when evaluating whether the patient has uterine malformation,preoperative systematic consultation and complete auxiliary examination are particularly important to avoid inappropriate diagnosis and treatment.
作者
李元元
张倩
吴莺
金志春
LI Yuanyuan;ZHANG Qian;WU Ying;JIN Zhichun(School of Medical,Wuhan University of Science and Technology,Wuhan 430064,Hubei,China;Department of Reproductive,Hubei Maternal and Child Health Care Hospital,Wuhan 430064,Hubei,China)
出处
《中国性科学》
2024年第2期100-104,共5页
Chinese Journal of Human Sexuality
基金
湖北省卫生健康委员会中医药科研项目(ZY2021Z013)。
