Krentel Harald, De Wilde Rudy Leon
Clinic of Gynecology, Obstetrics and Gynecological Oncology, Bethesda Hospital Duisburg, Academic Teaching Hospital, Duisburg, Germany.
Clinic of Gynecology, Obstetrics and Gynecological Oncology, University Hospital for Gynecology, Pius-Hospital Oldenburg, Medical Campus University of Oldenburg, Germany.
Ann Med Surg (Lond). 2022 May 23;78:103809. doi: 10.1016/j.amsu.2022.103809. eCollection 2022 Jun.
Adenomyosis can cause symptoms like dysmenorrhea, dyspareunia, pelvic pain and bleeding disorders and is related to subfertility and obstetrical complications. The disease is probably underestimated and underdiagnosed because of difficulties in reliable clinical examination and imaging results. The age-related prevalence of adenomyosis still remains unclear. In this retrospective analysis we describe the rate of adenomyosis in two independent cohorts of patients undergoing hysterectomy for benign diseases (2011-2013 and 2015-2018) and its correlation to presurgical symptoms respectively indications for hysterectomy.
All surgeries have been performed in the same department of minimally invasive gynecological surgery by a total of two experienced surgeons following a surgical internal standard for the indication bleeding disorder, dysmenorrhea. We analyzed the overall rate of patients with adenomyosis in both cohorts and related the histological presence of adenomyosis to presurgical symptoms. We also analyzed a subgroup of postmenopausal patients with uterine prolapse.
In 307 patients we detected 42.0% of cases with histologically proven adenomyosis. In the group of patients with bleeding disorders and dysmenorrhea as indication for surgery we found the highest rate of adenomyosis (59.3%, cohort 1). 81,1% patients with adenomyosis (cohort 1) reported symptoms. In the subgroup of 42 postmenopausal patients, we found 23.8% of cases with adenomyosis.
Our data shows that a positive anamnesis regarding the symptoms bleeding disorders and dysmenorrhea is suspicious for adenomyosis. In hysterectomy specimen adenomyosis can be found in more than 40%. The role of adenomyosis-related symptoms requires further investigation, especially in adolescent and postmenopausal patients.
子宫腺肌病可引起痛经、性交困难、盆腔疼痛和出血紊乱等症状，并与生育力低下及产科并发症相关。由于可靠的临床检查和影像学结果存在困难，该疾病可能未得到充分重视和诊断。子宫腺肌病的年龄相关患病率仍不清楚。在这项回顾性分析中，我们描述了两组因良性疾病接受子宫切除术的独立患者队列（2011 - 2013年和2015 - 2018年）中子宫腺肌病的发生率及其与术前症状和子宫切除指征的相关性。
所有手术均由两位经验丰富的外科医生在同一微创妇科手术科室按照手术内部标准进行，手术指征为出血紊乱、痛经。我们分析了两个队列中子宫腺肌病患者的总体发生率，并将子宫腺肌病的组织学存在情况与术前症状相关联。我们还分析了一组子宫脱垂的绝经后患者亚组。
在307例患者中，我们检测到42.0%的病例经组织学证实患有子宫腺肌病。在以出血紊乱和痛经为手术指征的患者组中，我们发现子宫腺肌病的发生率最高（59.3%，队列1）。81.1%的子宫腺肌病患者（队列1）报告有症状。在42例绝经后患者的亚组中，我们发现23.8%的病例患有子宫腺肌病。
我们的数据表明，关于出血紊乱和痛经症状的阳性病史可疑为子宫腺肌病。在子宫切除标本中，可发现超过40%的子宫腺肌病。子宫腺肌病相关症状的作用需要进一步研究，尤其是在青少年和绝经后患者中。
