The endometrium and endometriosis
The endometrium and endometriosis
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DOI：
10.1007/978-94-011-3864-2_4
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发表时间：
1991
期刊：
影响因子：
--
通讯作者：
S. Smith
中科院分区：
文献类型：
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作者：
S. Smith
子宫内膜异位症是生殖医学面临的最有趣和困难的条件之一。这种情况的特征是在子宫腔外发现与子宫内膜组织学相似的组织。围绕这种情况的病因的争议必须集中在调节子宫内膜分化和增殖的内分泌，旁分泌和自分泌因子。20世纪20年代，Sampson首次将子宫内膜异位症描述为一个独立的实体1，由于大多数疾病发生在盆腔，这导致了最初的假设，即单纯性子宫内膜异位症2，这取决于月经时子宫内膜的逆行通过。这一假说最近得到了证实，Halmeel等3发现52例输卵管未闭妇女经前期绝育后，90%的妇女腹腔内有血。在输卵管阻塞的妇女中，腹膜液中的血液明显减少。其他几位作者4 - 6证实了腹腔液中存在子宫内膜腺体，尽管子宫内膜细胞占细胞的不到20%，其余为巨噬细胞和淋巴细胞7，8。因此，很可能大多数女性都经历过月经逆行。如果着床假说是正确的，那么子宫内膜异位症的女性一定不同于正常女性，因为她们的子宫内膜异位症具有更大的着床和生长能力，或者因为她们的腹膜腔环境有利于子宫内膜的性质。
Endometriosis represents one of the most intriguing and difficult conditions facing reproductive medicine. The condition is characterized by the finding of tissue with histological similarities to endometrium, outside of the uterine cavity. The controversy surrounding the aetiology of this condition must centre on the endocrine, paracrine and autocrine factors that regulate endometrial differentiation and proliferation. The first description of endometriosis as a discrete entity was made in the 1920s1by Sampson, and as most of the disease was found in the pelvis this led to the initial hypothesis of simple implantation2, which would be dependent on the retrograde passage of endometrium at menstruation. This hypothesis has gained credence more recently, as Halmeel al.3showed blood in the peritoneal cavity of 90% of 52 women with patent fallopian tubes having sterilization in the premenstrual period. The presence of blood in peritoneal fluid was significantly reduced in women with occluded tubes. The presence of endometrial glands in peritoneal fluid was confirmed by several other authors4–6though the endometrial cells constitute less than 20% of the cells, the rest being macrophages and lymphocytes7,8. Thus it is likely that most women experience retrograde menstruation. If the implantation hypothesis is correct, then women with endometriosis must differ from normal women either because their endometriosis has a greater capacity to implant and grow or because the environment of their peritoneal cavity favours the nature of the endometrium.