Deeply infiltrating endometriosis: pathogenetic implications of the anatomical distribution
Deeply infiltrating endometriosis: pathogenetic implications of the anatomical distribution
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DOI：
10.1093/humrep/del079
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发表时间：
2006-07-01
影响因子：
6.1
通讯作者：
Bricou, Alexandre
中科院分区：
文献类型：
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作者：
Chapron, Charles;Chopin, Nicolas;Bricou, Alexandre
背景：了解组织学证实的深度浸润性子宫内膜异位症(DIE)病变的解剖分布是否有助于了解其发病机制。方法：1992年6月至2004年12月的观察性研究(1992年至2000年的回顾研究；2001年至2004年的前瞻性研究)。连续426例盆腔疼痛患者接受了完全手术切除的死亡病例。根据四种不同的可能性对病变进行分类：(I)首先，病变被分类为位于盆腔前部或后部。(Ii)其次，模具分为左、中、右三种。(Iii)第三，死亡性病变分为盆腔或腹部。(4)第四，可能出现在右侧和/或左侧的死亡性损害被归类为单侧或双侧。结果：426例患者共发现死亡病灶759个，其中膀胱48个(6.3%)，子宫骶部(USL)400个(52.7%)，阴道123个(16.2%)，输尿管16个(2.1%)，肠道172个(22.7%)。盆腔病变(n=730个病变)明显多于腹部(n=29个病变)(P<；0.0001)。盆腔死亡性病变明显更多地位于骨盆后间隔[682个死亡性病变(93.4%)比48个死亡性病变(6.6%)；P<；0.0001]。盆腔死亡性病变明显更多地位于左侧。单侧盆腔死亡者的解剖分布在三组间有显著差异：左侧(32.0%)、中位(284个；52.8%)和右侧(82个；15.2%)(P<；0.0001)。在有侧方病变的患者中，左侧病变的发生率(67.8%)显著高于右侧病变(32.2%，82个病变)(P<；0.0001)。当我们包括双侧盆腔死亡性病变的患者时，也观察到类似的易感性(P=0.0031)。在整个(盆腔和腹部)死亡性病变中也观察到了同样的显着不对称分布。结论：我们的结果表明，模具病变的分布是不对称的。这可能与左、右半骨盆的解剖差异和腹腔液的流动有关。这些发现支持这样一种假设，即反流的子宫内膜细胞的逆行月经与DIE的发病机制有关。
BACKGROUND: To investigate whether knowledge of the anatomical distribution of histologically proven deeply infiltrating endometriosis (DIE) lesions contributes to understanding the pathogenesis. METHODS: Observational study between June 1992 and December 2004 (retrospective study between 1992 and 2000; prospective study between 2001 and 2004). Continuous series of 426 patients suffering from pelvic pain who underwent complete surgical exeresis of DIE. DIE lesions were classified according to four different possibilities: (i) Firstly, DIE lesions were classified as located in the anterior or posterior pelvic compartment. (ii) Secondly, DIE were classified as left, median and right. (iii) Thirdly, DIE lesions were classified as pelvic or abdominal. (iv) Fourthly, DIE lesions that could present in a right and/or left location were classified as unilateral or bilateral. RESULTS: These 426 patients presented 759 histologically proven DIE lesions: bladder (48 lesions; 6.3%); uterosacral (USL) (400 lesions; 52.7%); vagina (123 lesions; 16.2%); ureter (16 lesions; 2.1%) and intestine (172, 22.7%). DIE lesions are significantly more often located in the pelvis (n = 730 lesions) than in the abdomen (n = 29 lesions) (P < 0.0001). Pelvic DIE lesions are significantly more often located in the posterior compartment of the pelvis [682 DIE lesions (93.4%) versus 48 DIE lesions (6.6%); P < 0.0001]. Pelvic DIE lesions are significantly more frequently located on the left side. For patients with unilateral pelvic DIE lesions, the anatomical distribution is significantly different in the three groups: left (172 lesions; 32.0%), median (284 lesions; 52.8%) and right (82 lesions; 15.2%) (P < 0.0001). For patients with lateral lesions, left DIE lesions (172 lesions; 67.8%) were found significantly more frequently than right DIE lesions (82 lesions; 32.2%) (P < 0.0001). A similar predisposition was observed when we included patients with bilateral pelvic DIE lesions (P = 0.0031). The same significantly asymmetric distribution is observed for total (pelvic and abdominal) DIE lesions. CONCLUSIONS: Our results demonstrate that distribution of DIE lesions is asymmetric. It is possible that this is related to the anatomical difference between the left and right hemipelvis and to the flow of peritoneal fluid. These findings support the hypothesis that retrograde menstruation of regurgitated endometrial cells is implicated in the pathogenesis of DIE.