Ovarian endometrioma: severe pelvic pain is associated with deeply infiltrating endometriosis
Ovarian endometrioma: severe pelvic pain is associated with deeply infiltrating endometriosis
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DOI：
10.1093/humrep/der462
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发表时间：
2012-03-01
影响因子：
6.1
通讯作者：
Borghese, Bruno
中科院分区：
文献类型：
--
作者：
Chapron, Charles;Santulli, Pietro;Borghese, Bruno
本研究的目的是评估严重的术前疼痛的意义，患者提出卵巢上皮性腺瘤（OMAh.Three百例连续的组织学证实的OMA 2004年1月至2010年5月之间在一所大学的三级转诊中心。对每例患者进行了所有可识别的肿瘤病变的完全手术切除。采用10 cm视觉模拟量表（VAS）评估疼痛强度。当VAS为1.07时，疼痛被认为是重度。前瞻性术前评估疼痛症状（VAS）的类型和严重程度与子宫肌瘤和相关的深度浸润性子宫内膜异位症的术前结果（手术切除和组织学分析）进行比较。通过单因素分析和多元回归分析，子宫骶韧带受累与慢性盆腔疼痛严重程度[比值比（OR）2.1; 95可信区间（CI）：1.14.3]和深度性交困难相关（OR 2.0; 95 CI：1.13.5）;阴道受累与下尿路症状强度较高相关（OR 13.4; 95 CI：3.255.8）;肠受累与排尿困难严重程度增加相关（OR 5.2; 95 CI：2.7 ± 10.3）和胃肠道症状（OR 7.1; 95 CI：3.3 ± 15.3）。在这种情况下，医生应该进行适当的术前影像学检查，以评估相关的深部结节的存在，并告知患者，以计划手术干预策略。
The objective of this study was to evaluate the significance of severe preoperative pain for patients presenting with ovarian endometrioma (OMA).Three hundred consecutive patients with histologically proven OMA were enrolled at a single university tertiary referral centre between January 2004 and May 2010. Complete surgical excision of all recognizable endometriotic lesions was performed for each patient. Pain intensity was assessed with a 10-cm visual analogue scale (VAS). Pain was considered as severe when VAS was epsilon 7. Prospective preoperative assessment of type and severity of pain symptoms (VAS) was compared with the peroperative findings (surgical removal and histological analysis) of endometriomas and associated deeply infiltrating endometriosis. Correlations were sought with univariate analysis and a multiple regression logistic model.After multiple logistic regression analysis, uterosacral ligaments involvement was related with a high severity of chronic pelvic pain [odds ratios (OR) 2.1; 95 confidence interval (CI): 1.14.3] and deep dyspareunia (OR 2.0; 95 CI: 1.13.5); vaginal involvement was related with a higher intensity of lower urinary symptoms (OR 13.4; 95 CI: 3.255.8); intestinal involvement was related with an increased severity of dysmenorrhoea (OR 5.2; 95 CI: 2.710.3) and gastro-intestinal symptoms (OR 7.1; 95 CI: 3.315.3).In case of OMA, severe pelvic pain is significantly associated with deeply infiltrating lesions. In this situation, the practitioner should perform an appropriate preoperative imaging work-up in order to evaluate the existence of associated deep nodules and inform the patient in order to plan the surgical intervention strategy.