摘要
目的通过对PubMed数据库中英文病例的总结分析,为子宫附腔(accessory cavitated uterine mass,ACUM)的诊疗提供参考。方法利用PubMed数据库检索关于ACUM报道的所有英文文献。通过阅读全文,总结分析ACUM的临床表现、诊断、治疗及预后。结果共收集到文献报道23篇,ACUM共计45例。ACUM好发于年轻女性,平均发病年龄为23.3岁,仅39.3%(11/28)的患者有生育史。ACUM的主要症状是进行性痛经(75.6%,34/45),其次是以单侧髂窝区为主的持续性盆腔痛(44.4%,20/45)和腹痛(24.4%,11/45)。超声和MRI是诊断ACUM的主要影像学方法。ACUM的术前诊断率仅有46.7%(21/45)。57.8%(26/45)的患者在术前接受了止痛药、避孕药、地诺孕素、非甾体类抗炎药、甲氨蝶呤等药物治疗,但治疗效果均不理想。手术切除病灶是治疗ACUM的主要方法,手术可经腹腔镜或宫腹腔镜联合进行(73.3%,33/45),也可经腹进行(24.4%,11/45)。91.7%(33/36)的患者术后症状消失,8.3%(3/36)的患者症状得到缓解。结论ACUM是一种罕见的梗阻性生殖道畸形,由于对该疾病认识不足,临床上极易误诊及漏诊,导致延误治疗。诊断ACUM的关键是应考虑到ACUM的可能以及完善超声和/或盆腔MRI检查。手术切除病灶是治疗ACUM的有效方法,多可经腹腔镜手术进行。
Objective To provide references for the diagnosis and treatment of accessory cavitated uterine mass(ACUM)by summarizing and analyzing English case reports in PubMed.Methods A comprehensive literature search was conducted in PubMed database to identify all English-language case reports documenting ACUM.Clinical manifestations,diagnosis,treatment,and prognosis of ACUM were systematically analyzed through full-text review.Results Twenty-three published articles reporting 45 cases of ACUM were included.ACUM predominantly affects young nulliparous females,with an average age of onset of 23.3 years.and only 39.3%(11/28)of patients had a history of childbirth.The primary symptom of ACUM was progressive dysmenorrhea(75.6%,34/45),followed by persistent pelvic pain predominantly in the unilateral iliac fossa area(44.4%,20/45)and abdominal pain(24.4%,11/45).Ultrasound and MRI were the main imaging modalities for ACUM diagnosis.The preoperative diagnostic rate of ACUM was only 46.7%(21/45).57.8%(26/45)of patients received preoperative treatment with analgesic,contraceptive,dienogest,non-steroidal anti-inflammatory drugs,methotrexate,and other medications,but none showed satisfactory efficacy.Surgical resection of the lesion was the the primary method for treating ACUM,performed via laparoscopy or combined hysterolaparoscopy(73.3%,33/45),or laparotomy(24.4%,11/45).Postoperatively,91.7%(33/36)of patients experienced complete symptom disappearance,and 8.3%(3/36)achieved symptom relief.Conclusions ACUM is a rare obstructive female genital malformation.Due to insufficient clinical awareness,it is highly prone to misdiagnosis,missed diagnosis,and delayed treatment.The key to diagnosis ACUM lies in considering ACUM as a differential diagnosis and performing comprehensive ultrasound and/or pelvic MRI examinations.Surgical resection of the lesion is an effective treatment,preferably via laparoscopic approach.
作者
李海燕
廖梓韵
欧阳振波
陈钰
何玉甜
钟碧婷
LI Hai-yan;LIAO Zi-yun;OUYANG Zhen-bo;Chen Yu;HE Yu-tian;ZHONG Bi-ting(Department of Gynecology,the Affiliated Guangdong Second Provincial General Hospital of Jinan University,Guangzhou 510317,China)
出处
《妇产与遗传(电子版)》
2024年第4期40-47,共8页
Obstetrics-Gynecology and Genetics (Electronic Edition)
基金
广东省医学科学技术研究基金项目(B2023039)
广东省颐养基金项目(JZ2022001-4)。
关键词
子宫附腔
苗勒管发育异常
生殖道畸形
痛经
盆腔痛
Accessory cavitated uterine mass
Müllerian anomaly
Genital malformation
Dysmenorrhea
Pelvic pain
