Clinical Analysis Of 321 Cases Of Uterine Adenomyosis

[Objective]This article presents a retrospective analysis of clinical data of 321 patients who had done hysterectomy and proved to be adenomyosis by pathology in No. 2 hospital of Jilin Uiversity from Jan. 1999 to Dec. 2003. Etiopathogenesis and the methods of diagnosis and treatment have been discussed, in order to raise the diagnosis accuracy.[Methods]Clinical data of 321 patients who had done hysterectomy and proved to be adenomyosis by pathology in these five years were retrospectively analyzed. Divide the patients into five groups by years. Age, the history of pregnancy, delivery and surgery, symptom and sign, pelvic sonography, preoperative diagnosis, finding of operation, and pathology were treat with statistics analysis, to find out etiopathogenesis, coincidence rate between pathology and preoperative diagnosis, and to analyze reason of misdiagnosis and missed diagnosis.[Results] The incidence of uterine adenomyosis was 13.7% (321/ 2349) in this study. Average age is 42.8±5.9y, 81.0% of cases is between 36 and 50y. 96.3% of these patients have the history of pregnancy and 94.4% has the history of delivery. Clinical diagnostic symptoms were dysmenorrhoe (66.4%), abnormal menstruation (65.1%), abnormal uterine bleeding (20.9%). Augmentation of uterine was 94.1% and tenderness was 30.5% in gynecologial examination, and diffuse thickening was 68.9%, uterine volume less than pregnancy in eight weeks was 71.0%. Pelvic sonography was myometrium thickening (34.9%), nonuniform echo (52.6%), uterine cavity line shift (28.7%), tiny light spot echo and little dark space (short line, 28.7%). Coincidence rate between pathology and sonography is 77.5%, rate of missed diagnosis and misdiagnosis is 22.5%. Pelvic sonography provided an accurate diagnosis of adenomyosis in the 51.6% of cases in 1999, and 81.4% in 2003. Coincidence rate between pathology and preoperative diagnosis is 82.6%, rate of missed diagnosis and misdiagnosis is 17.4%. Preoperative diagnosis provided an accurate diagnosis of adenomyosis in the 58.5% of cases in 1999, and 89.2% in 2003. Optimal treatment was hysterectomy, 56.4% is subtotal hysterectomy, 40.2% is total hysterectomy. Pathology after surgery diagnosis was adenomyosis (66.4%), adenomyosis and leiomyoma of uterus (19.0%), adenomyosis and chocolate cyst of ovary (9.7%).[Conclusion]Adenomyosis is one of the most common gynecological benign diseases. Incidence of this disease is 13.7%, eighty-one percent is between 36 and 50 years old. Multiple pregnancy and delivery, operation of the uterus may be the key factor of etiology. The etiology of this disease may be related to the stimulation of high level of estrogen. Dysmenorrhea is one useful symptom. Diffuse enlarge of uterus with tenderness is often find in gynecologial examination. The rate of preoperative diagnosis is 82.6%, and the rate of misdiagnosis and missed diagnosis is 17.4%. Therefore, we must combine etiology, symptom, gynecologial examination and ultrasound to make diagnosis. Adenomyosis is often complicated with leiomyoma and/or chocolate cyst of ovary; so we must distinguish carefully and depress the rate of misdiagnosis and missed diagnosis.