Basak S, Saha A
Department of Obstetrics and Gynaecology, Diana, Princess of Wales Hospital, Grimsby,
J Obstet Gynaecol. 2009 Aug;29(6):533-5. doi: 10.1080/01443610903074341.
Underlying adenomyosis is often the cause of treatment failure for patients undergoing Mirena insertion, endometrial ablation and/or hysteroscopic resection for abnormal uterine bleeding and/or pelvic pain. In this cohort of abnormal uterine bleeding, clinicians rarely considered adenomyosis as a differential diagnosis. In such cases, gynaecologists concentrated primarily on menstrual flow. Symptoms of pelvic pain, dyspareunia, pelvic pressure symptoms and type of dysmenorrhoea were not queried. Frequently, no correlation was sought to account for a uterus noted to be enlarged either clinically or at hysteroscopy. Given the limitation of ultrasound scan (USS) in diagnosing adenomyosis, and gynaecologists' reliance on USS findings, adenomyosis often remains undiagnosed before a hysterectomy. An earlier diagnosis of adenomyosis requires a good history, correlation of clinical examination and ultrasound scan findings and a back-up MRI service. Once adenomyosis is suspected, women can be appropriately counselled so that they are fully aware of the possible failure of conservative management. If conservative management is chosen, they should be followed-up and hysterectomy offered for persistent symptoms.
子宫腺肌病常常是接受曼月乐环置入、子宫内膜消融和/或宫腔镜切除治疗异常子宫出血和/或盆腔疼痛的患者治疗失败的原因。在这个异常子宫出血队列中，临床医生很少将子宫腺肌病作为鉴别诊断。在这种情况下，妇科医生主要关注月经量。盆腔疼痛、性交困难、盆腔压迫症状和痛经类型等症状并未被询问。临床上或宫腔镜检查时，子宫增大的情况通常也未被探究其相关性。鉴于超声扫描（USS）在诊断子宫腺肌病方面的局限性，以及妇科医生对超声扫描结果的依赖，子宫腺肌病在子宫切除术前常常仍未被诊断出来。子宫腺肌病的早期诊断需要详细病史、临床检查结果与超声扫描结果相互印证，以及借助磁共振成像（MRI）检查。一旦怀疑患有子宫腺肌病，就可以对女性进行适当的咨询，使她们充分了解保守治疗可能失败的情况。如果选择保守治疗，应对她们进行随访，对于持续出现症状的患者应考虑子宫切除术。
