背景与目的 子宫腺肌症（Adenomyosis, AM），简称腺肌症，是一种子宫内膜腺体和间质在子 宫肌层中异位生长的疾病，伴有周围肌细胞的增生和肥大，导致子宫呈弥漫性增大。一 般认为，子宫腺肌症患者常在四十岁左右因痛经、经量增多等症状就诊，而近期研究发 现，年轻患者越来越多，且经常以不孕为主诉就诊。CA125 水平的升高是与子宫腺肌 症最为相关的血液化验，经阴道超声是最常用的术前影像学检查。与子宫腺肌症的高 发病率相对的是，我们对其临床病理表现、发病机制的认识目前仍较少。随着术前评估 手段和微创治疗技术的发展，妇科医生为那些有生育需求的子宫腺肌症患者行保留生 育能力、改善临床症状、解决生育困难的治疗成为可能。本研究旨在更系统、全面的了 解子宫腺肌症的临床表现及其相关因素，从而为患者提供更恰当的治疗。 方法 选取2012 年3 月至2015 年9 月期间在北京协和医院妇产科因各种原因接受手术 治疗，术后经病理诊断为子宫腺肌症的患者共361 例，统计所有患者的临床资料并对 比绝经前和绝经后子宫腺肌症患者临床特点，发现多项临床特点上均有差异，故选定 绝经前、非妊娠状态、无盆腔感染、不合并生殖道畸形、不合并任何恶性疾病的患者共 291 例作为研究对象，重新统计其临床资料，并进行后续的差异性和相关性分析。 结果 1. 临床特点：患者手术时年龄中位数是40 岁。有39.5%的患者有出血模式异常， 最常见的是经量增多（24.4%）。68.0%的患者都有痛经，其中①超过2/3 是中重 度痛经，②超过1/2 的痛经患者都有进行性加重。另有17.5%的患者有不孕的 主诉。同时有9.3%的患者无任何症状。患者CA125 中位数水平为65.9U/ml， 其中72.4%的患者存在血清CA125 的异常升高。24.6%的患者术前超声提示子 宫肌壁增厚，这其中有80.5%为子宫后壁增厚。85.6%患者超声提示肌层回声不 均。术前36.4%的患者临床诊断子宫腺肌症的。子宫处理方式上有71.5%的患 者进行了病灶切除，手术路径方面，开腹手术占37.8%。38.8%的患者合并子宫 内膜异位症，其中最多的是卵巢型，占68.1%，同时以中重度为主（74.4%）。 58.1%的患者合并平滑肌瘤。 2. 相关性及差异性分析：合并内异症的患者手术更早，痛经更多、更重、更容易 进行性加重，CA125 水平更高。CA125 升高的患者痛经更多、更重、更容易进 行性加重，更多子宫肌壁增厚，更多合并内异症。对于CA125 水平过高，但临 床无恶性肿瘤提示时，或可以GnRH 治疗作为鉴别手段之一。有疼痛的患者手 术年龄更小，CA125 水平更高且更常出现CA125 升高，更多子宫肌壁增厚。 结论 1. 症状： 痛经68%；疼痛的患者手术更早，更多CA125 升高，值也更高，更多 子宫肌壁增厚，更多合并内异症。 2. CA125：72%患者升高；CA125 升高的患者痛经更多、更重、更多进行性加重， 更多膀胱刺激，更多子宫肌壁增厚，更多合并内异症且更严重。GnRHa 治疗可能作为 鉴别CA125 极度升高的手段之一。 3. B 超：25%子宫肌壁增厚，后壁占80.5%；86%肌层回声不均。 4. 36.4%患者能获得术前诊断。 5. 合并内异症39%，中重度占74.4%，卵巢型68.1%；合并内异症的患者手术更 早，痛经更多、更重、更多进行性加重，更多直肠刺激，CA125 更多升高。

BACKGROUND AND PURPOSE: Adenomyosis (AM) is the benign invasion of endometrium into the myometrium, producing a diffusely enlarged uterus which microscopically exhibits ectopic non-neoplastic, endometrial glands and stroma surrounded by the hypertrophic and hyperplastic myometrium. Generally believed that patients with adenomyosis often consult in the age of forth decade about dysmenorrhea, menorrhea or other symptoms. Recently there are more young patients with the complain about infertility. Elevated levels of CA125 are the most relevant blood lab test associated with adenomyosis. Transvaginal ultrasound is the most commonly used preoperative imaging examination. And the high incidence of adenomyosis beyond our understanding of its clinical pathology, pathogenesis. With the development of preoperative assessment and minimally invasive technology, gynecologists get the possibility to maintain fertility, improve clinical symptoms and solve the problems of fertility for adenomyosis patients. This study aims to provide a more systematic and comprehensive understanding of the clinical manifestations of adenomyosis and its associated factors, so as to we can provide individual patients with more appropriate individual treatment. METHODS: Collect clinical profiles of patients who underwent surgical treatment in the Department of Obstetrics and Gynecology in the Peking Union Medical College Hospital during March 2012 to September 2015 with postoperative pathological diagnosis of adenomyosis. After statistics of all 361 patient’s clinical profiles and comparison of clinical manifestation between premenopausal and postmenopausal adenomyosis patients, we exclude patients who are postmenopausal, pregnant, have pelvic infection, genital malformations or any malignant disease. Clinical profiles of 291 cases were studied and the differences and correlation analysis were carried out based on this. RESULTS: 1. Clinical manifestation: the median age of patients is 40 years old. 39.5% of patients had abnormal bleeding patterns, and the most common abnormality is menorrhea (24.4%). 68.0% of patients have dysmenorrhea, more than 2/3 of patients with dysmenorrhea is moderate to severe, more than 1/2 of patients with dysmenorrhea turn more sever. Another 17.5% of patients had infertility complaints. While 9.3% of patients don’t have any symptoms. The median CA125 level was 65.9 U / ml, and 72.4% of patients had abnormal serum CA125. 24.6% of patients showed thickening of uterine wall in preoperative ultrasound, of which 80.5% was posterior wall. 85.6% of patients showed nonuniform echo of myometrium in ultrasonography. 36.4% of patients get clinical diagnosis of adenomyosis before the surgery. 71.5% of patients underwent lesion resection and 37.8% of patients underwent laparotomy. 38.8% of patients with endometriosis, of which the most common type is ovarian EM, accounting for 68.1%, while the main are moderate or severe (74.4%). 58.1% of patients have leiomyoma. 2. Correlation analysis: patients with endometriosis underwent surgery earlier, have more dysmenorrhea, are more severe, more easily developed, have higher CA125 level. CA125 abnormal patients with abnormal serum CA125 have more dysmenorrhea, are more severe, more easily developed, more uterine wall thickening, more endometriosis. If patient has a over high serum CA125 level, but without malignant sign, might be treated with GnRHa as one of the means of differential diagnosis. Patients with pain are younger, and have higher CA125 levels and more abnormal CA125, more uterine wall thickening. CONCLUSION: 1. Symptoms: 68% of patients have dysmenorrhea; pain is negatively correlated to age and positively correlated to CA125 elevation, CA125 value, uterine wall thickening and endometriosis. 2. CA125: increased in 72% of patients; elevation of CA125 is positively correlated to dysmenorrhea, severity of dysmenorrhea, exacerbation of dysmenorrhea, bladder irritation, uterine wall thickening, endometriosis and the severity of endometriosis. 3.Ultrasonography: 25% have uterine wall thickening, 80.5% is the posterior wall; 86% showed nonuniform echo in myometrium. 4. 36.4% of patients got preoperative diagnosis. 5. Endometriosis: 39% have endometriosis, 74.4% of which is moderate to severe, 68.1% of which is ovarian type; endometriosis is negatively correlated to age and positively correlated to dysmenorrhea, severity of dysmenorrhea, exacerbation of dysmenorrhea, rectal distention stimulation and CA125 elevation.