Struble Jennifer, Reid Shannon, Bedaiwy Mohamed A
Department of Obstetrics and Gynecology, University of Saskatchewan, Saskatoon, Saskatchewan, Canada.
Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver, British Columbia, Canada.
J Minim Invasive Gynecol. 2016 Feb 1;23(2):164-85. doi: 10.1016/j.jmig.2015.09.018. Epub 2015 Sep 30.
Adenomyosis is a heterogenous gynecologic condition. Patients with adenomyosis can have a range of clinical presentations. The most common presentation of adenomyosis is heavy menstrual bleeding and dysmenorrhea; however, patients can also be asymptomatic. Currently, there are no standard diagnostic imaging criteria, and choosing the optimal treatment for patients is challenging. Women with adenomyosis often have other associated gynecologic conditions such as endometriosis or leiomyomas, therefore making the diagnosis and evaluating response to treatment challenging. The objective of this review was to highlight current clinical information regarding the epidemiology, risk factors, pathogenesis, clinical manifestations, diagnosis, imaging findings, and treatment of adenomyosis. Several studies support the theory that adenomyosis results from invasion of the endometrium into the myometrium, causing alterations in the junctional zone. These changes are commonly seen on imaging studies such as transvaginal ultrasound (TVUS) and magnetic resonance imaging (MRI). The second most common theory is that adenomyosis results from embryologic-misplaced pluripotent mullerian remnants. Traditionally, adenomyosis was only diagnosed after hysterectomy; however, studies have shown that a diagnosis can be made with biopsies at hysteroscopy and laparoscopy. Noninvasive imaging can be used to help guide the differential diagnosis. The most common findings on 2-dimensional/3-dimensional TVUS and MRI are reviewed. Two-dimensional TVUS and MRI have a respectable sensitivity and specificity; however, recent studies indicate that 3-dimensional TVUS is superior to 2-dimensional TVUS for the diagnosis of adenomyosis and may allow for the diagnosis of early-stage disease. Management options for adenomyosis, both medical and surgical, are reviewed. Currently, the only definitive management option for patients is hysterectomy.
子宫腺肌病是一种异质性的妇科疾病。子宫腺肌病患者可有多种临床表现。子宫腺肌病最常见的表现是月经过多和痛经；然而，患者也可能无症状。目前，尚无标准的诊断影像学标准，为患者选择最佳治疗方法具有挑战性。患有子宫腺肌病的女性通常还伴有其他妇科疾病，如子宫内膜异位症或平滑肌瘤，因此诊断和评估治疗反应具有挑战性。本综述的目的是强调有关子宫腺肌病的流行病学、危险因素、发病机制、临床表现、诊断、影像学表现及治疗的当前临床信息。多项研究支持子宫腺肌病是由子宫内膜侵入肌层导致交界区改变引起的这一理论。这些变化在经阴道超声（TVUS）和磁共振成像（MRI）等影像学检查中常见。第二常见的理论是子宫腺肌病由胚胎期错位的多能苗勒管残余物引起。传统上，子宫腺肌病仅在子宫切除术后才能诊断；然而，研究表明，在宫腔镜检查和腹腔镜检查时通过活检也可作出诊断。非侵入性成像可用于帮助指导鉴别诊断。本文综述了二维/三维经阴道超声和磁共振成像的最常见表现。二维经阴道超声和磁共振成像具有较高的敏感性和特异性；然而，最近的研究表明，三维经阴道超声在子宫腺肌病的诊断方面优于二维经阴道超声，可能有助于早期疾病的诊断。本文还综述了子宫腺肌病的药物和手术治疗选择。目前，对于患者来说，唯一确定的治疗选择是子宫切除术。
