腹腔镜对腹膜型子宫内膜异位症的诊治意义

Accuracy of laparoscopic diagnosis of peritoneal endometriosis

目的分析腹腔镜下腹膜型子宫内膜异位症的病变特点,评价腹腔镜配合病理诊断子宫内膜异位症的价值。方法对136例临床考虑子宫内膜异位症的患者进行腹腔镜手术,切除异位的病变组织常规送病理检查确诊。结果①136例病变中白色病变为82例,黑色病变为34例,红色病变为20例。其中病理确诊为子宫内膜异位症的有115例(84.6%),但有21例没有内异症的证据(15.4%),其中100%的红色病变、88.2%的黑色病变和31.7%的白色病变病理证实为子宫内膜异位症。②最常见的病变部位是宫骶韧带和阔韧带后叶,依次为侧盆壁腹膜、卵巢窝、卵巢表面、子宫膀胱反折腹膜、输尿管和肠管浆膜面。③在取检的236处异位病变中,210处(89.0%)病变经组织学证实。腹腔镜和病理的符合率病变在宫底韧带是88.2%、阔韧带是92.3%、侧盆壁是91.4%、卵巢窝是100%、膀胱反折腹膜是54.5%、输尿管是70.0%、肠管浆膜面是33.3%。结论子宫内膜异位症病灶可以形形色色,以白色病变多见,而红色病变的病理符合率最高,不是所有腹腔镜下可疑异位病灶为子宫内膜异位症,常见的发病部位主要位于宫骶韧带和阔韧带后叶,病理检查配合腹腔镜诊断治疗子宫内膜异位症是必要的。

[Objective] Laparoscopy is the standard method to visually identify endometriotic lesions under magnification within and outside the minor pelvis. The aim of this study was to analyze the accuracy of laparoscopic visualization in diagnosing the various endometriotic sites as confirmed histologically. [Methord] Presumed endometriotic sites were observed in 136 patients operated on under the clinical suspicion of endometriosis. Targeted biopsies were performed for histologic corroboration, comparing the lapar...