探讨子宫囊性腺肌瘤(UCA)患者的临床表现、诊断及治疗方法。

选择2023年6月于成都市第一人民医院就诊的1例UCA自发破裂患者(患者1)为研究对象。采用回顾性分析法，收集患者1入院后检查结果、主要治疗经过、病理学检查及随访结果。以"子宫囊性腺肌瘤""子宫腺肌病囊肿""cystic adenomyoma""adenomyotic cyst""uterine adenomyoma"等为中、英文关键词，在中国知网、万方数据知识服务平台、维普中文科技期刊数据库及PubMed数据库中，检索关于UCA患者的相关研究文献。本次文献检索时间设定为上述数据库建库至2024年8月31日。本研究遵循的程序符合2013年修订的《世界医学协会赫尔辛基宣言》要求。

①患者1为女性，38岁，G₁P₁，剖宫产术分娩，平素月经规律，无痛经，末次月经后3 d，因"突发下腹痛，呈持续性绞痛，伴恶心呕吐"于本院急诊科就诊，经治疗后疼痛缓解；3 d后阴道彩色多普勒超声提示异常；7月3日于本院住院治疗。患者1入院后腹部增强CT结果提示：子宫形态失常、强化不均匀，子宫后方片团灶影(4.5 cm×4.4 cm×4.5 cm)与子宫分界不清，考虑子宫肿瘤性病变可能，对其入院初步诊断为盆腔肿物，疑似附件包块、肠道肿瘤或骶前肿瘤。对其采取单孔腹腔镜探查术与UCA切除术治疗，术中见盆腔内陈旧性出血，子宫后壁下段近宫颈后壁可见一突起(5 cm×5 cm×4 cm)，内含一巧克力样液体囊肿。根据病史、临床表现、辅助检查、手术及术后切除组织病理学检查结果，患者1被确诊为UCA陈旧性破裂。术后采取亮丙瑞林，并长期口服地诺孕素治疗。术后约2年时的阴道超声结果提示：子宫大小为6.3 cm×4.1 cm×4.3 cm，肌壁回声不均匀，可见多个低回声结节，较大者位于后壁，约为2.0 cm×1.9 cm×1.7 cm，边界较清晰，形态欠规则。②文献复习结果：根据本研究设定的文献检索策略，排除年龄<30岁青少年型UCA患者后，检索到关于年龄≥30岁成年人型UCA患者相关研究文献为25篇，涉及54例UCA患者，加上患者1，共计55例UCA患者被纳入以下分析。这55例患者中位年龄为38.6岁；临床表现中，14例(25.5%)为经期延长、月经量增多伴腹痛，11例(20.0%)痛经进行性加重，17例(30.9%)不规则阴道流血，7例(12.7%)突发性腹痛或慢性盆腔痛，6例(10.9%)盆腔或宫腔占位；仅12例(12/55)术前被诊断为UCA，其余43例(78.2%)均被临床误诊；组织病理学检查诊断均为UCA；47例(85.5%)采取手术治疗，7例采取超声引导下穿刺术，1例采取保守治疗，经治疗后，上述临床症状均缓解。

UCA术前诊断困难，易被误诊，需结合患者临床表现、影像学检查及病理学检查进行诊断，手术是其主要治疗方法，预后较好。

To explore the clinical manifestations, diagnosis and treatment methods of patients with uterine cystic adenomyoma (UCA).

A patient with spontaneous rupture of UCA who was treated at the Chengdu First People′s Hospital in June 2023 (patient 1) was selected as the subject. A retrospective analysis method was used to collect the patient′s examination results after admission, main treatment process, pathological examination and follow-up results. Keywords such as " uterine cystic adenomyoma" " uterine adenomyosis cyst" " cystic adenomyoma" " adenomyotic cyst" " uterine adenomyoma" in both Chinese and English were used to retrieve literature related to UCA from CNKI, Wanfang Data Knowledge Service Platform, VIP Chinese Science and Technology Journal Database, and PubMed literature databases. The literature search time was set from the establishment of the above databases to August 31, 2024. The procedures followed in this study were in accordance with the requirements of Helsinki Declaration of the World Medical Association revised in 2013.

①Patient 1, a 38-year-old woman (G₁P₁), had a history of cesarean delivery. Her menstrual cycle was regular, without dysmenorrhea, and her last menstruation started on June 25, 2023. On June 28, 2023, she was admitted to emergency department of our hospital due to " sudden lower abdominal pain, continuous colic, with nausea and vomiting". And the pain was relieved after treatment. On June 30, 2023, follow-up at our hospital′s gynecology outpatient clinic showed significant pain relief, but transvaginal color Doppler ultrasound indicated abnormalities. She was hospitalized in our hospital on July 3, 2023. Enhanced abdominal CT after admission revealed abnormal uterine morphology, uneven enhancement, a 4.5 cm × 4.4 cm × 4.5 cm mass posterior to the uterus, poorly defined, suggesting a uterine tumor. The initial diagnosis upon admission was pelvic mass, suspected adnexal mass, intestinal tumor, or sacral tumor. On July 6, 2023, single-port laparoscopy and UCA resection were performed. Intraoperatively, old hemorrhage and a 5 cm × 5 cm × 4 cm uterine mass near the posterior cervix were found, containing a chocolate-like cystic lesion. Based on medical history, clinical presentation, auxiliary tests, surgery, and pathological examination results, patient 1 was diagnosed with ruptured UCA. After the operation, she was treated with leuprorelin and long-term oral administration of dienogest. The results of vaginal ultrasound about 2 years after the operation showed a uterus of 6.3 cm × 4.1 cm × 4.3 cm with multiple hypoechoic nodules, the largest (2.0 cm × 1.9 cm × 1.7 cm) in the posterior wall, with relatively clear borders but irregular shape. ②Literature review results: According to the literature search strategy set for this study, excluding cases of juvenile UCA in patients under 30 years of age, 25 articles related to adult UCA patient studies were retrieved, involving 54 UCA patients. Combining patient 1, a total of 55 UCA patients were studied. The median age of these 55 patients was 38.6 years; 14 patients (25.5%) had clinical symptoms of prolonged menstruation, increased menstrual flow with abdominal pain, 11 patients (20.0%) had progressively severe dysmenorrhea, 17 patients (30.9%) had irregular vaginal bleeding, 7 patients (12.7%) had acute abdominal pain or chronic pelvic pain, and 6 patients (10.9%) had pelvic or uterine cavity mass. Only 12 patients (21.8%) were preoperatively diagnosed with UCA, while the other 43 patients (78.2%) were misdiagnosed, and all 55 cases were diagnosed as UCA by histopathological examination. And 47 patients (85.5%) underwent surgical treatment, 7 patients underwent ultrasound-guided puncture, and 1 patient underwent conservative treatment. After treatment, the above clinical symptoms were relieved.

UCA is difficult to diagnose preoperatively and is easily misdiagnosed. It needs to be diagnosed based on the patient′s clinical manifestations, imaging examinations, and pathological examinations. Surgery is the main treatment method with a relatively good prognosis.