Visible and non-visible endometriosis at laparoscopy in fertile and infertile women and in patients with chronic pelvic pain: A prospective study
Visible and non-visible endometriosis at laparoscopy in fertile and infertile women and in patients with chronic pelvic pain: A prospective study
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DOI：
10.1093/humrep/11.2.387
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发表时间：
1996-02-01
影响因子：
6.1
通讯作者：
Vanrell, JA
中科院分区：
文献类型：
--
作者：
Balasch, J;Creus, M;Vanrell, JA
在连续100例因不孕症（组1，n = 52）、慢性盆腔疼痛（组2，n = 18）或输卵管绝育（组3，n = 30，无症状生育妇女）接受腹腔镜检查的患者中，在子宫骶韧带视觉正常腹膜区行腹膜活检，1组26例（50%）、2组8例（44.4%）、3组13例（43.3%）发现盆腔其他部位子宫内膜异位症。多数女性(在组2组1 80.7%,87.5%,100%,组3)阶段我疾病,发病率的病变的独特的外表相似的三组患者和7%的妇女和15%(7/47)的患者有子宫内膜异位症腹腔镜只有细微的异位腹膜病变(非“典型的”),Uterosacral活检显示,3例异位组织的存在(5.7%),2例(11%),3例(10%)在组1中,2、3例，2例患者中1例，3例患者中2例腹腔镜检查未发现子宫内膜异位症；因此，组织学研究显示，在腹腔镜检查中，11%（5/47）的肉眼子宫内膜异位症患者和6%（3/53）的无子宫内膜异位症患者存在正常腹膜内内膜异位症，有肉眼和/或显微镜子宫内膜异位症的女性既往口服避孕药的使用明显高于无子宫内膜异位症的女性。我们的前瞻性研究显示，在慢性盆腔疼痛患者和无症状妇女（可生育和不育）中，子宫内膜异位症（包括显微镜下的形式）的患病率都很高（45-50%）。这就支持了一个现代概念，即在许多女性中，子宫内膜异位症可能是一种生理上的疾病，而可能只有在一些患者中，少量的子宫内膜异位症是一种“烦恼”，会影响她们的生殖健康，并可能产生症状（例如盆腔疼痛），因此应该被定义为一种“疾病”。以前使用过口服避孕药可能会增加患子宫内膜异位症的风险。
In 100 consecutive patients who were undergoing laparoscopy for infertility (group 1, n = 52), chronic pelvic pain (group 2, n = 18) or tubal sterilization (group 3, n = 30, asymptomatic fertile women), peritoneal biopsies were taken from areas of visually normal peritoneum of uterosacral ligaments, Twenty-six patients in group 1 (50%), eight patients in group 2 (44.4%) and 13 patients in group 3 (43.3%), were found to have laparoscopic evidence of endometriosis elsewhere in the pelvis, The majority of women (80.7% in group 1, 87.5% in group 2, and 100% in group 3) had stage I disease, The incidence of the distinctive appearances of the lesions was similar in the three groups of patients and 7% of all women or 15% (7/47) of those patients having endometriosis at laparoscopy had only subtle (non-'typical') endometriotic peritoneal lesions, Uterosacral biopsies showed the presence of endometriotic tissue in three cases (5.7%), two cases (11%) and three cases (10%) in groups 1, 2, and 3 respectively, One of the two patients in group 2 and two of the three patients in group 3 had no evidence of endometriosis at laparoscopy; thus histological study revealed the presence of endometriosis in normal peritoneum in 11% (5/47) of patients having macroscopic endometriosis and in 6% (3/53) of patients without endometriosis at laparoscopy, Previous oral contraceptive users were significantly higher among women having macroscopic and/or microscopic endometriosis than among women without the condition, In conclusion, our prospective study shows a high prevalence (45-50%) of endometriosis (including microscopic forms) in both patients with chromic pelvic pain and asymptomatic women (fertile and infertile), thus supporting the modern concept that in many women endometriosis may be a paraphysiological condition while probably only in some patients small amounts of endometriosis are an 'annoyance' with implications to their reproductive health and may produce symptoms (e.g. pelvic pain) and therefore should be defined as a 'dis-ease'. Previous use of oral contraceptives may increase the risk of developing endometriosis.