输卵管子宫内膜异位症39例临床分析
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摘要
目的:探讨输卵管子宫内膜异位症(TEM)的临床特点、发病相关因素,以及其与卵巢子宫内膜异位症(EMs)的关系。方法:回顾分析2005至2017年北京大学人民医院收治的病理诊断为TEM的39例患者的临床资料,包括患者年龄、生育情况、避孕方法、病理特点及合并妇科疾病情况。结果:39例患者均为术后病理确诊,平均年龄41.6岁(18～59岁),平均孕次1.79次(0～6次),平均产次0.82次(0～2)。11例有不孕史,20例有人工流产史,8例有剖宫产史,1例绝育术,10例宫内节育器避孕。术后病理提示,单纯输卵管子宫内膜异位症3例,合并盆腔其他部位子宫内膜异位症26例,合并单侧卵巢子宫内膜异位症者均与输卵管子宫内膜异位症病变同侧。结论:TEM的临床表现无特异性,诊断均需手术病理确诊,其发生可能与输卵管绝育术及放置宫内节育器、流产等宫腔操作等因素相关。TEM可能与卵巢子宫内膜异位症的发生有一定相关性。
Objective: To investigate the clinical characteristics and etiological factors of tubal endometriosis( TEM) and to analysis the correlation between TEM and ovarian endometrium. Method: The information of these patients ' clinical data,fertility status,contraceptive method,pathological characteristics and simultaneous gynecologic diseases were retrospectively analyzed in 39 cases of TEM. Results: All of these patients were diagnosed by pathology after operation.The medial age was 41.6 years( 18 ～ 59 years).The average pregnancy rate was 1.79( 0～6),average delivery rate was 0.82( 0 ～ 2).11 cases had history of infertility,20 cases had history of artificial abortion,8 cases had previous cesarean section,1 case had tubal sterilization,10 cases had intrauterine device. The pathology showed only 3 patients had TAE without any other gynecologic diseases,while others all had simultaneous diseases,including 26 patients with endometriosis at other pelvic sites.All the simultaneous ovarian endometriosis happened in the same side of the TEM.Conclusion: The final diagnosis of TEM depends on pathological examination since there has no specific clinical characteristics.The related factors of TEM may include tubal sterilization,IUD and other uterine cavity operations. There could be some correlation between TEM and ovarian endometriosis.
Objective: To investigate the clinical characteristics and etiological factors of tubal endometriosis( TEM) and to analysis the correlation between TEM and ovarian endometrium. Method: The information of these patients ' clinical data,fertility status,contraceptive method,pathological characteristics and simultaneous gynecologic diseases were retrospectively analyzed in 39 cases of TEM. Results: All of these patients were diagnosed by pathology after operation.The medial age was 41.6 years( 18 ～ 59 years).The average pregnancy rate was 1.79( 0～6),average delivery rate was 0.82( 0 ～ 2).11 cases had history of infertility,20 cases had history of artificial abortion,8 cases had previous cesarean section,1 case had tubal sterilization,10 cases had intrauterine device. The pathology showed only 3 patients had TAE without any other gynecologic diseases,while others all had simultaneous diseases,including 26 patients with endometriosis at other pelvic sites.All the simultaneous ovarian endometriosis happened in the same side of the TEM.Conclusion: The final diagnosis of TEM depends on pathological examination since there has no specific clinical characteristics.The related factors of TEM may include tubal sterilization,IUD and other uterine cavity operations. There could be some correlation between TEM and ovarian endometriosis.
引文
[1]Yuan Z,Wang L,Zheng WX,et al.Tubal origin of ovarian endometriosis[J].Modern Pathol,2014,27(8):1154-1162
[2]魏利,吴凯彦,王轶英.卵巢子宫内膜异位症的输卵管起源及其临床意义[J].实用妇产科杂志,2015,31(11):811-812
[3]薛瑞洪,张健.输卵管子宫内膜异位症的研究现状[J].现代妇产科进展,2017,26(6):471-473
[4]张信美,石一复,林俊.输卵管子宫内膜异位症21例临床分析[J].现代妇产科进展,2002,11(4):265-267
[5]夏舟岚,华凯.输卵管子宫内膜异位症10例报道[J].浙江临床医学,2001,3(2):115-116
[6]Rock JA,Elisa T,Horp AT,et al.Endometriosis and the development of tubo-peritoneal fistulas after ligation[J].Fertil Steril,1981,35(1):16-18
[7]王振海,陈文磊,张玉敏.绝育术后输卵管内膜异位症[J].中华妇产科杂志,1989,24(4):241-241
[8]刘珍,杨建,沈宗姬,等.输卵管子宫内膜异位症模型的建立[J].现代妇产科进展,2014,8(23):648-650
[9]Zheng X,Han H,Guan J.Clinical features of fallopian tube accessory ostium and outcomes after laparoscopic treatment[J].Int J Gynaecol Obstet,2015,129(3):260-263
[10]关菁教授谈:《子宫内膜异位症、不孕、输卵管功能》的相关问题[J].中国宫颈疾病网,2017-01-19
[11]Zheng WX,Li N,Wang J,et al.Initial endometriosis showing direct morphologic evidence of metaplasia in the pathogenesis of ovarian endometriosis[J].Int J Gynecol Pathol,2005,24(2):164-172
[12]Yuan Z,Wang YY,Janiel M,et al,Cell origin of endometriosis:contribution by the fallopian tube epitheliun[J].AM J Clin Exp Obstet Gynecol 2013,1(1):37-42
[13]Li J,Abushahin N,Pang S,et al.Tubal origin of"Ovarian"low-grade serous carcinoma[J].Mod Pathol,2014(24):1488-1499
[2]魏利,吴凯彦,王轶英.卵巢子宫内膜异位症的输卵管起源及其临床意义[J].实用妇产科杂志,2015,31(11):811-812
[3]薛瑞洪,张健.输卵管子宫内膜异位症的研究现状[J].现代妇产科进展,2017,26(6):471-473
[4]张信美,石一复,林俊.输卵管子宫内膜异位症21例临床分析[J].现代妇产科进展,2002,11(4):265-267
[5]夏舟岚,华凯.输卵管子宫内膜异位症10例报道[J].浙江临床医学,2001,3(2):115-116
[6]Rock JA,Elisa T,Horp AT,et al.Endometriosis and the development of tubo-peritoneal fistulas after ligation[J].Fertil Steril,1981,35(1):16-18
[7]王振海,陈文磊,张玉敏.绝育术后输卵管内膜异位症[J].中华妇产科杂志,1989,24(4):241-241
[8]刘珍,杨建,沈宗姬,等.输卵管子宫内膜异位症模型的建立[J].现代妇产科进展,2014,8(23):648-650
[9]Zheng X,Han H,Guan J.Clinical features of fallopian tube accessory ostium and outcomes after laparoscopic treatment[J].Int J Gynaecol Obstet,2015,129(3):260-263
[10]关菁教授谈:《子宫内膜异位症、不孕、输卵管功能》的相关问题[J].中国宫颈疾病网,2017-01-19
[11]Zheng WX,Li N,Wang J,et al.Initial endometriosis showing direct morphologic evidence of metaplasia in the pathogenesis of ovarian endometriosis[J].Int J Gynecol Pathol,2005,24(2):164-172
[12]Yuan Z,Wang YY,Janiel M,et al,Cell origin of endometriosis:contribution by the fallopian tube epitheliun[J].AM J Clin Exp Obstet Gynecol 2013,1(1):37-42
[13]Li J,Abushahin N,Pang S,et al.Tubal origin of"Ovarian"low-grade serous carcinoma[J].Mod Pathol,2014(24):1488-1499