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子宮腺肌子宮腺肌的臨床表現

Hot 5Viewed 368 times28-4-2023 07:28 PM

子宮腺肌是一種較為常見的婦科疾病,雖然可以治愈,但這種疾病對患者的傷害卻非常的大,那麼你知道子宮腺肌的發病原因是什麼嗎,子宮腺肌的臨床表現是什麼呢,子宮腺肌該怎樣去治療呢,預防子宮腺肌的方法是什麼呢,我們來看看下面的內容來了解一下吧。

子宮腺肌病是子宮內膜腺體和間質侵入子宮肌層形成瀰漫或局限性的病變,與子宮內膜異位症一樣,屬於婦科常見病和疑難病。子宮腺肌病多發生於30~50歲左右的經產婦,但也可見於年輕未生育的女性,這可能與各種宮腔操作手術增多有一定關係。約15%的患者合併子宮內膜異位症,約50%合併子宮肌瘤。本病的治療可用藥物干預,也可行手術治療,但根治較難,只有患者絕經後子宮腺肌症方可逐漸自行緩解。故而臨床治療方案的選擇,需結合患者的年齡、症狀及生育要求進行個體化選擇。

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  子宮腺肌病病因至今不明。目前的共識是因為子宮缺乏黏膜下層,因此子宮內膜的基底層細胞增生、侵襲到子宮肌層,並伴以周圍的肌層細胞代償性肥大增生而形成了病變。

  中醫認為本病由氣滯、寒凝、熱灼、氣虛、腎虛導致瘀血阻滯衝任、胞宮,經行不暢則痛經。瘀血阻滯衝任、胞宮為主要病機。

  臨床表現

  子宮腺肌病過去多發生於40歲以上的經產婦,但近些年呈逐漸年輕化趨勢,這可能與剖宮產、人工流產等宮腔手術增多有關。

  1.症狀

  (1)月經失調

  主要表現為經期延長、月經量增多,部分患者還可能出現月經前後點滴出血,嚴重的患者可以導致貧血。

  (2)痛經

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  特點是繼發性進行性加重的痛經。常在月經來潮前一周開始出現,當經期結束痛經即緩解。痛經初期服用止痛藥物可以緩解,但隨著病情進展,痛經需要服用的止痛藥物劑量明顯增加,使患者無法耐受。

  (3)其他

  大約有35%的患者無明顯症狀。

  2.體徵

  婦科檢查子宮常均勻增大呈球形,子宮腺肌瘤可表現為質硬的結節。子宮一般不超過孕12周大小。臨近經期,子宮有觸痛感;經期,子宮增大,質地變軟,壓痛比平時更明顯;經期後,子宮縮小。子宮常與周圍尤其是後面的直腸粘連而活動較差。15%~40%合併子宮內膜異位症,約一半患者合併子宮肌瘤。

  檢查

  1.影像學檢查

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  是術前診斷本病有效的手段。陰道超聲檢查敏感性達80%,特異性可達74%,較腹部探頭準確性高。子宮腺肌病時B超可見子宮均勻性增大,迴聲不均;子宮腺肌瘤時B超可見子宮呈不均勻增大,局部隆起,病灶內呈不均質高迴聲。MRI可在術前客觀的了解病變的位置及範圍,對決定處理方法有較大幫助。瀰漫性子宮腺肌症的MRI在T2WI上表現為子宮結合帶瀰漫性增厚;局限性子宮腺肌症在T2WI上表現為與結合帶信號相近的低信號腫塊影,邊界模糊。

  2.血清CA125

  部分子宮腺肌病患者血清CA125水平升高,這在監測療效上有一定價值。

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