Gkrozou Fani, Vatopoulou Anastasia, Skentou Chara, Paschopoulos Minas
Department of Obstetrics and Gynaecology, Medical School, University of Ioannina, 45500 Ioannina, Greece.
Diagnostics (Basel). 2023 Jun 27;13(13):2182. doi: 10.3390/diagnostics13132182.
Adenomyosis is a common chronic disease in women of reproductive age, characterised by the presence of ectopic endometrial tissue within myometrium. Even though adenomyosis presents with chronic pelvic pain, menorrhagia or abnormal uterine bleeding, dysmenorrhoea, and dyspareunia and is often recognised after hysterectomies. However, the development of ultrasonography and magnetic resonance imaging has improved the pre-operative diagnosis of the disease. Hysteroscopy provides information in real time from the uterine cavity and the offers the possibility of obtaining direct biopsies.
The literature was searched via Pubmed and Embase with the following headings: diagnosis of adenomyosis or adenomyoma and office hysteroscopy, hysteroscopy findings of adenomyosis or adenomyoma, treatment of adenomyosis or adenomyoma with office hysteroscopy.
The literature showed that hysteroscopy can identify superficial adenomyosis. There are a variety of hysteroscopic images that can be connected with the disease. New equipment like the spirotome has been used to access deeper layers of myometrium and obtain biopsies under direct vision from the adenomyotic areas. Different methods of treatment have been also described, like enucleation of focal superficial adenomyoma, coagulation, evacuation of cystic adenomyosis when the lesion is smaller than 1.5 cm, and resection of adenomyotic nodules in case of bigger lesions (>1.5 cm). Diffuse superficial adenomyosis is also managed by resection.
Hysteroscopy has revolutionised the approach to adenomyosis. It is a useful tool in assessing mainly superficial adenomyosis. The role of hysteroscopy in surgical management of adenomyosis need to be confirmed with further studies.
子宫腺肌病是育龄期女性常见的慢性疾病，其特征是子宫肌层内存在异位的子宫内膜组织。尽管子宫腺肌病表现为慢性盆腔疼痛、月经过多或异常子宫出血、痛经和性交困难，且常在子宫切除术后才被发现。然而，超声检查和磁共振成像的发展改善了该疾病的术前诊断。宫腔镜检查可实时提供来自子宫腔的信息，并提供获取直接活检的可能性。
通过PubMed和Embase以以下标题检索文献：子宫腺肌病或腺肌瘤的诊断与门诊宫腔镜检查、子宫腺肌病或腺肌瘤的宫腔镜检查结果、门诊宫腔镜治疗子宫腺肌病或腺肌瘤。
文献表明，宫腔镜检查可识别浅表性子宫腺肌病。有多种可与该疾病相关的宫腔镜图像。像螺旋刀这样的新设备已被用于进入子宫肌层更深层，并在直视下从子宫腺肌病区域获取活检。还描述了不同的治疗方法，如局灶性浅表腺肌瘤摘除术、凝固术、当病变小于1.5 cm时对囊性子宫腺肌病进行引流，以及对于较大病变（>1.5 cm）切除子宫腺肌病结节。弥漫性浅表性子宫腺肌病也通过切除术进行处理。
宫腔镜检查彻底改变了子宫腺肌病的治疗方法。它是评估主要为浅表性子宫腺肌病的有用工具。宫腔镜检查在子宫腺肌病手术管理中的作用需要进一步研究来证实。
