青春期子宫内膜异位症的诊治

Adolescence endometriosis diagnosis and treatment

关键词:  青春期  子宫内膜异位症  诊断

Key words:  adolescence  endometriosis  diagnosis

摘要:

青春期子宫内膜异位症的发病率为19%～73%，BMI和月经情况为其两大危险因素；国内对青春期子宫内膜异位症的诊断率不高，有待于患者和医生双方加以重视；早期诊治可以阻断疾病发展及不孕症的发生，对青春期患者更有意义；其发病机制有多种学说，主要与苗勒氏管结构异常有关；发病年龄最早可在初潮前乳房刚发育时开始；症状以周期性和非周期性下腹痛为主，可伴有胃肠道、膀胱症状以及月经不调；病理以非典型病变为主，最常见的病变部位是直肠子宫陷凹；超声可作为青少年慢性盆腔痛的首选辅助检查，而MRI对青少年生殖道畸形有重要的诊断价值；血清CA125水平可用于协助诊断，而血清CA199水平通常作为治疗效果的监测指标；目前腹腔镜是最佳的诊疗方法；术后辅以药物治疗，同时进行心理治疗等综合治疗；药物治疗要持续到完成生育。

Abstract:

The incidence rate of adolescence endometriosis ranges from 19% to 73%; BMI and menstrual are its two major risk factors. The diagnosis rate of adolescence endometriosis is not high in China, both patients and doctors need to get attention. Early diagnosis and treatment can block the development of the disease and the incidence of infertility, more meaningful to adolescent patients. The pathogenesis is of a variety of theories, mainly related to the abnormalities of Mullerian structure. The earliest age of onset is just before menarche when the breast began to develop. The main symptoms are periodic and non-periodic abdominal pain, may be associated with the gastrointestinal tract and bladder symptoms, and irregular menstruation. Atypical lesions are the mainly pathology. The most common lesion is the rectal uterine pouch. Ultrasound can be used as the first choice of teenagers with chronic pelvic pain, and MRI have important diagnostic value on adolescent reproductive tract abnormalities. Serum CA125 levels can be used to assist in the diagnosis, serum CA199 level is usually as a therapeutic effect monitoring indicators; Laparoscopy is the best method of diagnosis and treatment. Medication, the same time combined with psychotherapy and comprehensive treatment should be used after operation until the completion of childbearing.