| Objective:To summarize and analyze the clinical data of adenomyosis in young reproductive period and perimenopausal period,and to explore the current incidence and epidemiological trend,main clinical manifestations,surgical options and characteristics of tumor markers of adenomyosis.To provide clinical reference data for early prevention,early intervention,reasonable control and long-term management of adenomyosis in young patients of reproductive age so as to protect fertility.Methods:A total of 1804 patients with adenomyosis admitted to our hospital due to adenomyosis from January 2017 to December 2021 were collected.EXCEL was used to establish a database file,and SPSS26.0 software was used to analyze the clinical data of patients with adenomyosis by retrospective analysis and grouping control.To analyze the clinical related factors and clinical characteristics of adenomyosis.The count data were analyzed by chi-square test,and the measurement data were analyzed by t test or non-parametric test.Linear regression and Logistic regression analysis were used for regression analysis,and P<0.05 was used for statistical difference.Results:(1)Investigation and analysis of the incidence and epidemiological trend of adenomyosis1)The incidence rate of adenomyopathy:the number of hospitalized patients in 2017was 457,with a constituent ratio of 25.33%;The number of cases in 2018 was 374(20.73%);The number of cases in 2019 was 359(19.90%);The number of cases in 2020 was 261(14.47%);The number of cases in 2021 was 353(19.57%).2)Geographical distribution of adenomyosis:72.39%of the patients(1360/1804 cases)came from the central and western plain area of Jilin Province,followed by the southeastern mountainous area of Jilin Province(270 cases,14.97%)and the Inner Mongolia Plateau(183cases,10.14%).3)The status of different occupational incidence rate of adenomyosis:among the occupational types of patients,teachers,students,civil servants and clerks were the most,accounting for 562 cases,accounting for 43.67%of the total number of patients.406 cases(31.55%)were farmers.4)Comparison of different age distribution:the age of 1804 patients with adenomyosis ranged from 22 to 75 years,with an average age of 44.66±6.96 years.The peak age of the disease was 45-50 years old,which was the susceptible population,with a total of 544 cases(30.16%).A total of 1804 patients with adenomyosis were divided into the reproductive period group(≤40 years old)and the perimenopausal period group(>40 years old).There were 466 patients with adenomyosis in reproductive period,accounting for 25.8%;1338cases(74.2%)were perimenopausal.(2)Investigation and analysis of clinical related data of adenomyosis1)Comparison of the correlation between weight change and adenomyosis:the average BMI of reproductive period patients was 24.49±4.00kg/m~2,and the average BMI of perimenopausal period patients was 24.83±3.41kg/m~2.The mean BMI of both groups was overweight(24.0≤BMI<28.0).2)The change status of anemia and hemoglobin in patients with adenomyosis:the average hemoglobin value was 112.79±24.539g/L in patients with reproductive period and111.87±24.49g/L in patients with perimenopausal period.However,hemoglobin values were close to anemic state in both groups.3)Investigation and analysis of the reproductive status of patients with adenomyosis:there were statistically significant differences between the two groups in natural labor,cesarean section,the number of induced abortion and whether to have children(P<0.05).The history of vaginal delivery was 41%in fertile period and 72%in perimenopause period.The abortion history was 63%in fertile period and 71%in perimenopause period.The cesarean section rate was 48%in fertile period and 26%in perimenopause period.(3)Investigation and analysis of main clinical manifestations of adenomyosis1)Comparison of the main clinical manifestations of the two groups of patients with adenomyosis:57.59%(1039/1804 cases)of the patients had signs of uterine enlargement.57.15%(1031/1804 cases)of the patients had dysmenorrhea symptoms.Secondly,781patients(781/1804 cases,43.29%)had increased menstrual volume,661 patients(36.64%)had irregular bleeding,328 patients(18.18%)had pelvic pain,109 patients(6.04%)had compression symptoms,and 87 patients(4.82%)had menstrual disorder.2)Correlation analysis between dysmenorrhea and severity of uterine enlargement:the proportion of patients in the two groups was inversely proportional to the degree of uterine enlargement and the severity of dysmenorrhea.The main clinical manifestation of perimenopausal women was increased uterine volume(826 cases,61.73%,826/1338 cases).Dysmenorrhea was the most common manifestation in women of reproductive period,with a total of 319 cases,accounting for 68.45%(319/466 cases).3)The prevalence of dysmenorrhea,the main clinical symptom of adenomyosis,was57.15%(1031/1804 cases).The patients with mild dysmenorrhea were the most,705 cases,accounting for 68.38%(705/1031 cases).The number of patients with mild dysmenorrhea peaked 5 years later than that of patients with moderate dysmenorrhea.4)The main clinical sign of adenomyosis-analysis of related factors of enlarged uterus:57.6%of patients with adenomyosis had signs of enlarged uterus.Symptoms of increased uterine volume were more common in patients without irregular bleeding symptoms and in perimenopausal women.5)Investigation of menstrual changes in patients with adenomyosis:there was a significant difference between menstrual volume increase and dysmenorrhea grade.For each grade increase in dysmenorrhea degree,the likelihood of menstrual volume increased by1.502 times.(4)Analysis of different pathological types of adenomyosis:the number of patients with localized adenomyosis was the largest,a total of 271 cases,accounting for 48.6%.There were 157 cases of diffuse adenomyosis,accounting for 28.1%.(5)Treatment options of patients with adenomyosis:45.0%(753/1804 cases)of patients with adenomyosis chose curettage or hysteroscopy(levonorgestrel intrauterine sustained release system,namely Mirenole ring).Among the surgical options related to the treatment of adenomyosis,such as total hysterectomy(694 cases,41.5%)and adenomyomectomy(81cases,4.8%),the number of patients who chose total hysterectomy was the largest.Among the patients with adenomyosis in the child-bearing period,193 cases(41.4%,193/466 cases)chose total hysterectomy.(6)Correlation analysis of positive indicators of sub-tumor markers:The mean value of CA125 in this study was 57.75 U/m L.34.9%(510/1461 cases)had elevated CA125,and46.47%(237/510 cases)had CA125 values ranging from 35 to 70U/m L.In addition,the peak of CA125 positive was 45-50 years old,and the number of patients with increased CA199 value was 40-45 years old,5 years earlier than the peak of CA125 positive.Conclusions:1.Young women in reproductive period are the key population of adenomyosis.Attention should be paid to the reproductive health of young women during their childbearing years.2.Dysmenorrhea is more common in young women of reproductive age.It is necessary to strengthen the propaganda and education of dysmenorrhea,early diagnosis and fertility protection.3.Increased uterine volume is more common in perimenopausal women,with serious lesions and prolonged course of disease,which should not be ignored.It is hoped that treatment should be performed in the early stage,when the symptoms are controllable and the condition is stable,so as to avoid delaying the disease.4.The number of patients in the child-bearing period who chose total hysterectomy was the largest.It should be detected and treated as early as possible to avoid permanent loss of reproductive function due to total hysterectomy. |
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