子宫内膜异位症盆腔病灶的腹腔镜诊断准确性评价

Histologic analysis of laparoscopic diagnosis of endometriosis

目的评价腹腔镜对子宫内膜异位症(内异症)不同盆腔病灶的诊断准确率。方法对85例腹腔镜诊断的内异症病灶行切除术,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内异症病灶的阳性预测值。结果85例腹腔镜诊断的内异症患者中,55例有卵巢子宫内膜异位囊肿;获取148份内异症腹膜病灶组织;69份卵巢子宫内膜异位囊肿。盆腔内异症病灶中蓝色病灶最常见,占32.5%(70/217),其次是卵巢子宫内膜异位囊肿占31.8%(69/217)。腹腔镜诊断盆腔内异症与病理诊断比较,阳性预测值(PPV)为70.0%。其中以蓝色病灶和卵巢子宫内膜异位囊肿的病理诊断阳性率最高,分别为91.4%及89.9%。结论腹腔镜诊断盆腔内异症病灶,并不一定均能被病理检查证实,但对蓝色病灶及卵巢子宫内膜异位囊肿的病理诊断阳性率较高。

[Objective] To estimate the accuratissime of lapamseopic diagnosis to endometriosis of different pelvic focus of infection. [Methods] A study of 85 patients with diagnosis of endometriosis laparoscopically were excised and examined pathologically. Pathologic diagnosis was taken as the standard, positive predictive value （PPV） was calculated in different type of endometriosis with lapamscopic diagnosis. [Results] 55 patients in 85 had ovarian endometriotic cysts. Totally, 148 peritoneal endometriotic lesions, 69 ovarian endometriofic cysts were obtained. Black focus of infection was the most common in cavitas pelvis endometriosis （32.5% 70/217）, next adenoma endometrioides ovarii cystis （31.8% 69/217）. The PPV was 70% versus histologic diagnosis of peritoneal endometriosis. Lesions in black or adenoma endometrloides ovarii cystis were confirmed histologically in 94.2% and 84.7% respectively. [Conclusions] Laparoscopic diagnosis of cavitas pelvis endometrlosis are not more likely to be histological confirmed, but laparoscopic diagnosis in black or adenoma endometrioides ovarii cystis consistent with pathologic diagnosis is to be trusted.