盆腔子宫内膜异位症病灶分布特点及其腹腔镜诊断准确性的评价

Visual and histologic analysis of laparoscopic diagnosis of endometriosis

目的探讨盆腔子宫内膜异位症(内异症)病灶的分布特点以及腹腔镜用于诊断不同部位、不同类型内异症病灶的准确率及其与病理诊断的符合率。方法对62例腹腔镜诊断的内异症病灶行切除术,对肉眼正常的腹膜随机进行活检,并均送病理检查。以病理诊断为标准,计算腹腔镜诊断不同类型、不同部位以及不同颜色内异症病灶的阳性预测值、阴性预测值及敏感度、特异度。结果62例患者中,55例有卵巢子宫内膜异位囊肿。取得219份内异症腹膜病灶组织、54份肉眼正常腹膜组织以及71个卵巢子宫内膜异位囊肿;盆腔后半部腹膜内异症病灶占80.8%(177/219),左侧(58.0%,127/219)多于右侧(42.0%,92/219)。盆腔腹膜内异症病灶中蓝色病灶最常见,占39.3%(86/219)。腹腔镜诊断腹膜内异症与病理诊断比较,阳性预测值为67.6%,敏感度为93.7%,阴性预测值为81.4%,特异度为38.3%。其中以蓝色病灶和左侧宫骶韧带处病灶的病理诊断阳性率最高,分别为94.2%及84.7%。卵巢子宫内膜异位囊肿中,左侧占43.6%(24/55),右侧占27.3%(15/55),双侧占29.1%(16/55),其中80.3%(57/71)的卵巢子宫内膜异位囊肿被病理诊断证实。肉眼正常腹膜活检54份标本中,10例(18.5%)病理检查阳性。结论盆腔内异症病灶的分布呈非对称性,盆腔后部多于前部,左侧多于右侧;腹腔镜下所见的蓝色病灶及宫骶韧带病灶的病理诊断阳性率较高。

Objective To determine the characteristics of anatomical distribution of pelvic endometriosis and the correlation between visual and histologic findings of endometriosis at laparoscopy. Methods A prospective study of 62 patients undergoing laparoscopy for the pelvic pain, infertility and/or pelvic masses was carried out. All lesions with the diagnosis of endometriosis laparoscopically were excised and examined pathologically. Normal-appearing peritoneal biopsies were obtained randomly. All lesions were identified by anatomical site and color of the foci. The positive predictive value （ PPV）, sensitivity, negative predictive value （NPV）, and specificity were determined for visually identified endometriosis versus the histologic findings. Results Totally, 219 peritoneal endometriotic lesions, 54 normal peritoneal biopsies, and 71 ovarian endometriotic cysts were obtained. Peritoneal lesions tended to locate in posterior part of the pelvis （80. 8%, 177/219） and in left （58.0%, 127/219） with most in black （39.2%）. The PPV was 67.6% ; sensitivity, 93.7% ; NPV, 81.4% ; and specificity, 38. 3% for visual versus histologic diagnosis of peritoneal endometriosis. Lesions in black or from sacral ligaments were confirmed histologically in 94.2% and 84.7% respectively, and 80. 3% （57/71） of ovarian endometriotic cysts diagnosed hy laparoscopy were confirmed histologically with 43.6% in the left , 27. 3% in the right; and 29. 1% （16/55） in both sides of the ovary. In addition, 18. 5% （ 10/54 ） of normal-appearing peritoneal biopsy were identified as endometriosis by pathological examination. Laparoscopy was confirmed to be in 100% diagnostic accordance with pathology for patients with endometriosis. Conclusions Our study showed asymmetrical distribution of pelvic endometriosis. Peritoneal lesions in black or from sacral ligament are more likely to be histologically confirmed, and microscopic lesions are not a rare phenomenon of endometriosis.