136例腹膜型子宫内膜异位症病变特点分析

The characteristics of endometriotic lesions in 136 women with peritoneal endometirosis

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实。结果①136例白色病变为82例,黑色病变为34例,红色病变为20例。其中病理确实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,92%的黑色病变和31%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%)病变经组织学证实。腹腔镜和病理的符合率在宫骶韧带是88.2%,阔韧带是94.9%,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%,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均为子宫内膜异位症;常见的发病部位主要位于宫骶韧带和阔韧带后叶,精确的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 pelvis. The aim of this study was to analyze the accuracy of laparoscopic diagnosis of various endometriotic lesions. Methods Endometriosis was clinical suspected in 136 women, who underwent laparoscopy and endometriotic sites diagnosed under endoscope were obtained biopsies, followed by pathologic examination. The laparoscopic diagnosis and pathology were compared. Results The pathology confirmed endometriosis in 115 patients （84.6%）, no evidence of endometriosis in 21 patients （15. 4%）. 100% of ＂red＂ lesions, 92 % of ＂black＂ lesions, and 31% of ＂white＂ lesions of endometriosis under laparoscope were confirmed pathologically. Of the 236 various suspected endometriotic lesions observed, 210 （89%） were confirmed pathologically. The accuracy of laparoscopic diagnosis in lesions at the ovarian fossa was 12 / 12 （ 100% ） , uterosacral ligaments 97/110 （88. 2%）, posterior surface of the broad ligaments 94/99 （94.9%）, pelvic lateral walls 22/25 （88. 4%）. vesicouterine fold of the peritoneum 54.5% ; ureturs 70% and bowel serosa, 33.3%. Conclusions Endometriosis appears as vary lesions, which may be confused with nonendometriotic lesions. Non - pathology - based diagnosis may lead to unnecessary treatment and surgery, preventing from proper therapy. Therefore, a carefully pathology confirmed diagnosis should still be the first step in diagnosis and treatment of endometriosis.