青少年子宫附腔畸形临床诊治分析(附1例报告及文献复习)

Clinical Diagnosis and Treatment Analysis of Accessory Cavity Uterine Malformation in Adolescents (with a Case Report and Literature Review)

摘要: 子宫附腔畸形(Accessory Cavitated Uterine Malformation, ACUM)是一种罕见的苗勒管发育异常，主要临床表现为初潮后逐渐加重的痛经，需与囊性子宫腺肌病、子宫肌瘤囊性变及其他阻塞性苗勒管畸形相鉴别。手术是目前主要的治疗方式。本文报告1例青少年女性患者，经期腹痛4年，伴进行性加重2年，需口服止痛药物缓解。2025年1月，妇科B超提示子宫肌瘤，子宫左侧壁结节样回声(1.5 cm × 1.3 cm)，考虑为子宫附腔畸形或内膜异位灶。盆腔磁共振成像(Magnetic Resonance Imaging, MRI)检查显示：1. 子宫左侧壁肌层囊性影伴局灶出血，建议结合B超进一步评估；2. 双侧髂血管旁及腹股沟区多发小淋巴结。于经期第2天行腹腔镜探查术，发现盆腔少量积血，无粘连。子宫大小正常，左侧壁圆韧带下方可见一大小约2.0 cm × 1.5 cm × 1.5 cm的凸起，质地稍硬，表面光滑。双侧附件外观未见明显异常。完整切除病变组织并送检，病理检查确诊为ACUM。

Abstract: Accessory Cavitated Uterine Malformation (ACUM) is a rare Müllerian duct anomaly characterized primarily by progressively worsening dysmenorrhea after menarche. It requires differentiation from cystic adenomyosis, cystic degeneration of uterine fibroids, and other obstructive Müllerian duct anomalies. Surgical intervention remains the primary treatment approach. This report details a case involving an adolescent female patient with a 4-year history of menstrual abdominal pain, progressively intensifying over the past 2 years and requiring oral analgesics for symptom control. In January 2025, gynecological ultrasonography indicated a uterine fibroid and revealed a nodular echo (1.5 cm × 1.3 cm) in the left uterine wall, suggestive of either ACUM or an endometriotic lesion. Pelvic Magnetic Resonance Imaging (MRI) demonstrated: 1. A cystic lesion with focal hemorrhage within the left uterine myometrium, warranting further ultrasound evaluation; 2. Multiple small lymph nodes are adjacent to the bilateral iliac vessels and in the inguinal regions. Diagnostic laparoscopy was performed on the second day of menstruation, identifying minimal pelvic hemoperitoneum without adhesions. The uterus exhibited normal dimensions, with a firm, smooth-surfaced protrusion (~2.0 cm × 1.5 cm × 1.5 cm) inferior to the left round ligament. Both adnexa appeared unremarkable. The lesion was completely resected and submitted for histopathological examination, which confirmed ACUM.