探讨子宫内膜非典型性息肉样腺肌瘤(APA)的临床特点、治疗及预后情况。

选取2012年9月1日至2019年10月1日，四川大学华西第二医院收治的经术后活组织病理学检查确诊为APA的16例患者为研究对象。采用回顾性分析方法，对其临床表现，术后活组织病理学检查、辅助检查、治疗结果及预后等进行分析。本研究遵循的程序符合2013年新修订的《世界医学协会赫尔辛基宣言》要求。

纳入本研究的16例APA患者的临床分析结果如下。①一般临床资料：患者发病年龄为23～59岁[(40.8±10.7)岁]；15例为绝经前女性，1例为绝经后女性。②临床表现：不规则阴道流血、异常阴道流液、尿频与尿痛、盆腔包块分别为12、2、1及1例。③术前合并症：术前合并≥1种合并症，如不孕症、子宫肌瘤、子宫内膜非典型增生等为11例，其余5例无合并症。④术前经阴道彩色多普勒超声检查结果：宫腔内未见明显异常为3例；提示子宫内膜回声欠均匀、泡状液性暗区、宫腔内血流信号丰富，未见确切占位为5例；提示宫腔内占位位于宫腔中下段，宫腔内血流信号丰富为8例。⑤术后活组织病理学检查结果：提示APA伴子宫恶性肿瘤及其癌前病变为5例，其中APA伴子宫内膜灶性癌变、子宫内膜高分化腺癌、子宫内膜癌肉瘤及子宫内膜非典型增生，分别为2、1、1与1例；而APA伴子宫内膜息肉、子宫内膜复杂性增生，以及单纯性APA伴鳞状上皮化生，分别为1、1与9例。⑥治疗及随访：6例接受子宫切除术；10例接受宫腔镜下病灶切除术。其中，6例有生育要求，术后仅1例自然妊娠，但是最终流产，其余5例均未妊娠。对16例患者的随访结果显示，1例失访，对其余15例随访7～85个月(中位随访时间为42个月)，尚未见APA复发。

APA多发生于绝经前女性，常合并子宫内膜恶性病变，术前诊断困难，需根据术后活组织病理学检查结果确诊。对于有生育需求的APA患者，采取保留生育功能治疗后，自然妊娠率较低。

To investigate the clinical characteristics, treatment and prognosis of atypical polypoid adenomyomas (APA), so as to provide the diagnosis and treatment ideas for this disease.

From September 1, 2012 to October 1, 2019, a total of 16 patients with APA finally diagnosed by pathological examination in West China Second University Hospital, Sichuan University were selected as research subjects. The clinical data of those 16 patients were collected by retrospective analysis method, so as to summarize clinical characteristics, histopathological examination results, auxiliary examination results, treatment and prognosis of APA patients. This study met the requirements of World Medical Association Declaration of Helsinki revised in 2013.

Clinical data analysis results of 16 APA patients included in the study were as follows. ①General clinical data: patients′ age ranged from 23 to 59 years old [(40.8±10.7) years old]. There were 15 cases of premenopausal women, and 1 case of postmenopausal woman. ②Clinical manifestations: 12 cases presented irregular vaginal bleeding, 2 cases presented abnormal vaginal fluid, 1 case presented frequent urination and pain, and 1 case was with pelvic mass. ③Preoperative complications: 11 cases had one or more complications, such as infertility, uterine fibroids, atypical endometrial hyperplasia, and the remaining 5 cases had no complications. ④Preoperative transvaginal color Doppler ultrasound: 3 cases had no obvious abnormalities in uterine cavity; 5 cases were not observed exact space occupation, but their endometrial echo was uneven and had the dark area of vesicular fluid, and 8 cases were observed exact space occupation and all the occupation were located in the middle and lower part of uterine cavity. Transvaginal color Doppler ultrasonography showed abundant blood flow in uterine cavity of these 13 cases. ⑤Postoperative histopathological examination: 5 cases indicated APA complicated with uterine malignant tumor or its precancerous lesion, including 2 cases of APA with endometrial focal canceration, 1 case of APA with highly endometrial differentiated adenocarcinoma, 1 case of APA with endometrial carcinosarcoma, 1 case of APA with atypical endometrial hyperplasia. Among the remaining 11 cases, 1 case was APA with endometrial polyp, 1 case was APA with endometrial complex hyperplasia, and another 9 cases were simple APA with squamous metaplasia. ⑥Treatment and follow-up: 6 cases underwent hysterectomy; the other 10 cases underwent hysteroscopic focal resection. Among the later 10 patients, 6 cases had fertility requirements, but only 1 case had natural pregnancy after surgery, and finally miscarried, the remaining 5 cases had no pregnancy. All of these patients, 1 case was lost and the remaining 15 cases was followed up for 7-85 months (median follow-up time was 42 months), no one was recurrent with APA.

APA mostly occurs in premenopausal women and often complicated with endometrial malignant tumor, which is difficult to be diagnosed preoperatively and depends on postoperative pathological examination. For APA patients with fertility desire, the natural pregnancy rate is low after fertility preservation treatment.