McCausland A M
Department of Obstetrics and Gynecology, University of California, Davis Medical School, Sacramento.
Am J Obstet Gynecol. 1992 Jun;166(6 Pt 1):1619-26; discussion 1626-8. doi: 10.1016/s0002-9378(11)91551-8.
The purpose of this study was to develop and clinically evaluate a hysteroscopic myometrial biopsy for diagnosing adenomyosis.
Ninety patients with menorrhagia had myometrial biopsies. The depth of adenomyosis was correlated with the severity of menorrhagia.
Of the 90 patients studied, 50 had hysteroscopically normal appearing cavities (i.e., without polyps or submucous myomas). Of those 50, 33 (66%) had significant adenomyosis (greater than 1 mm) as compared with controls (0.8 mm). A statistically significant correlation between the depth of adenomyosis and the severity of menorrhagia was found, (p = 0.05).
A myometrial biopsy can diagnose adenomyosis. Minimal adenomyosis can be treated definitively by endometrial ablation. Deep adenomyosis should be treated with a hysterectomy. Endometrial glands left under a scar could not only bleed and cause pain but also have malignancy potential. The scar may delay bleeding and the diagnosis of endometrial cancer. Routine myometrial biopsy at the time of operative hysteroscopy should be added to our diagnostic armamentarium.
本研究旨在开发并临床评估一种用于诊断子宫腺肌病的宫腔镜下肌层活检方法。
90例月经过多患者接受了肌层活检。子宫腺肌病的深度与月经过多的严重程度相关。
在研究的90例患者中，50例宫腔镜检查显示宫腔外观正常（即无息肉或黏膜下肌瘤）。在这50例中，与对照组（0.8毫米）相比，33例（66%）存在显著的子宫腺肌病（大于1毫米）。发现子宫腺肌病的深度与月经过多的严重程度之间存在统计学显著相关性（p = 0.05）。
肌层活检可诊断子宫腺肌病。轻度子宫腺肌病可通过子宫内膜消融术进行确定性治疗。重度子宫腺肌病应行子宫切除术。瘢痕下残留的子宫内膜腺体不仅会出血并引起疼痛，还可能具有恶性潜能。瘢痕可能会延迟出血和子宫内膜癌的诊断。在手术宫腔镜检查时应常规进行肌层活检，并将其纳入我们的诊断手段中。
