背景:附件空化子宫畸形(ACUM)是一个相对较新的术语,用于描述非通信,副子宫腔。ACUM以不同的术语发表,从青少年囊性子宫腺肌病到“子宫样肿块”。这项研究的目的是系统地识别所有ACUM病例和文献中描述的定义,不管标签,并识别形态学,流行病学,和临床特征以及管理,同时也突出了知识差距。
方法:对三个数据库进行了系统的文献检索,回顾囊性子宫肌层病变的所有记录。纳入符合ACUM常见定义的病例,并详细记录临床和影像学特征。这项工作已注册到PROSPERO,报告遵循PRISMA范围审查指南。
结果:共包括53篇文章,包括115例符合ACUM最低标准的病例。症状发作的中位年龄为17岁,初潮后不久出现痛经。共有19名妇女参加了会议。在超声波上,ACUM表现为单眼子宫肌层囊肿,通常与磨砂玻璃的内容。在磁共振成像(MRI)上也观察到出血内容,在T2和T1加权图像上具有高信号强度。95例(83%)通过手术治疗,具有主要非手术选择的趋势。虽然没有不良结果的报告,随后的生育力和妊娠的长期随访很少见.
结论:尽管其作为临床实体的认识日益提高,ACUM通常仍未被诊断,因为它与其他子宫肌层肿块相似。我们根据本综述中的数据为ACUM提出了统一的术语和定义。ACUM表现为空化病变,被子宫内膜包围,与子宫前外侧壁连续,位于圆形韧带和输卵管间质部的插入下方。与其他子宫异常相反,可以看到正常的子宫腔。需要未来的研究,使用ACUM的明确定义,并前瞻性地调查管理策略,包括患者报告的症状的长期随访,生育力,和妊娠结局。
BACKGROUND: Accessory cavitated uterine malformation (ACUM) is a relatively recent term used to describe a noncommunicating, accessory uterine cavity. ACUM have been published under different terms ranging from juvenile cystic adenomyosis to \"uterus-like mass\". The objective of this study was to systematically identify all cases of ACUM and definitions described in the literature, regardless of label, and identify morphological, epidemiological, and clinical characteristics as well as management, while also highlighting knowledge gaps.
METHODS: A systematic literature search of three databases was performed, reviewing all records of cystic myometrial lesions. Cases that fitted common definitions for ACUM were included and clinical and imaging characteristics were documented in detail. This work was registered to PROSPERO and reporting followed PRISMA guidelines for scoping reviews.
RESULTS: A total of 53 articles were included, comprising 115 cases that met the minimal criteria for ACUM. The median age at onset of symptoms was 17 years, presenting with dysmenorrhea soon after menarche. A total of 19 women were parous. On ultrasound, ACUM appears as unilocular myometrial cysts, usually with ground-glass content. Hemorrhagic content is also observed on magnetic resonance imaging (MRI), with high signal intensity on both T2 and T1-weighted images. Ninety-five (83%) cases were managed surgically, with a trend towards primary nonsurgical options. Although no adverse outcomes were reported, long-term follow-up on subsequent fertility and pregnancy was rare.
CONCLUSIONS: Despite its increasing recognition as a clinical entity, ACUM often remains underdiagnosed as it shares similarities with other myometrial masses. We propose a unified terminology and definition for ACUM based on the data in this
review. ACUM presents as a cavitated lesion, surrounded by a myometrial mantle, in continuity with the anterolateral uterine wall and located beneath the insertion of the round ligament and the interstitial portion of the fallopian tube. In contrast to other uterine abnormalities, a normal uterine cavity is visualized. Future studies are needed, using a clear definition for ACUM, and prospectively investigating management strategies, including long-term follow-up of patient-reported symptoms, fertility, and pregnancy outcomes.