Đặc điểm lâm sàng và cận lâm sàng của bệnh nhân bệnh tuyến cơ tử cung được phẫu thuật cắt tử cung tại Bệnh viện Phụ sản Trung ương

Adenomyosis, a condition characterized by the presence of endometrial tissue within the myometrium, presents a significant clinical challenge due to its diverse symptoms and impact on women's reproductive health and quality of life. While conservative management options exist, hysterectomy remains a definitive treatment for severe cases, particularly in women who have completed childbearing. Understanding the specific clinical and subclinical characteristics of patients undergoing hysterectomy for adenomyosis is crucial for improving diagnostic strategies and optimizing patient care. This study aims to describe the clinical and subclinical features of patients with adenomyosis who underwent hysterectomy at the Central Obstetrics Hospital, contributing valuable insights into the management of this complex gynecological disorder.

Gynecologists, obstetricians, reproductive health specialists, general practitioners managing women's health, medical students, and clinical researchers focused on uterine pathologies.

This retrospective study meticulously analyzed the medical records of 296 patients diagnosed with adenomyosis who underwent hysterectomy at the Central Obstetrics Hospital between January 2022 and December 2023. The primary objective was to characterize the clinical and subclinical profiles of these patients, providing a comprehensive overview of a population often presenting with severe symptoms. The cohort primarily comprised women around 46.6 years old, with a high parity (88.1% having two or more children) and a significant history of prior uterine interventions such as curettage or cesarean section.

Key clinical findings revealed that abdominal pain was almost universally reported (93.6%), with dysmenorrhea affecting 64.5% of patients. Abnormal uterine bleeding was also prevalent (79.4%), and a substantial proportion (66.5%) suffered from anemia, predominantly mild to moderate. Transvaginal ultrasound, a primary diagnostic tool, identified adenomyosis in 87.5% of cases, often presenting as diffuse lesions primarily located in the posterior uterine wall and fundus. Histopathological examination further indicated that over one-third of the patients had co-existing uterine fibroids. Prior to hysterectomy, most patients had received various conservative treatments, including pain relief (76%) and hormonal therapy (74%), highlighting the chronic nature and refractoriness of their symptoms to less invasive approaches.

The study underscores the varied and often severe clinical presentation of adenomyosis that necessitates hysterectomy, particularly after the failure of conservative management. It emphasizes the importance of advanced imaging techniques for diagnosis and acknowledges the frequent co-occurrence with conditions like uterine fibroids. These findings are vital for guiding clinical practice, improving pre-operative counseling, and developing more effective, individualized treatment pathways for women grappling with severe adenomyosis.