卵巢内异症囊肿患者盆腔病灶的解剖特征及其与疼痛的关系

Relationship of pelvic clinic-pathological features and the pain symptoms in ovarian endometrioma

目的探讨卵巢内异症囊肿患者盆腔内异症病灶的解剖特征及其与疼痛症状的关系。方法详细记录2005年2月至2009年2月在北京协和医院就诊的416例盆腔内异症患者的临床症状、腹腔镜检查和病理检查结果，以有无卵巢内异症囊肿分为两组，伴有卵巢内异症囊肿者338例为卵巢囊肿组，不伴有卵巢内异症囊肿的78例为非卵巢囊肿组。分析比较卵巢内异症囊肿患者盆腔不同部位以及不同类型内异症病灶的特征及其与疼痛症状的关系。结果（1）CA125水平：卵巢囊肿组为（61±39）kU／L，非卵巢囊肿组为（28±24）kU／L，两组比较，差异有统计学意义（P〈0．01）。（2）病灶类型：卵巢囊肿组338例患者中，115例囊肿位于左侧（34．0％），89例位于右侧（26．3％），134例位于双侧（39．6％）。卵巢囊肿组患者中95．8％（324／338）合并盆腔其他类型的内异症病灶，其中，48．5％（164／338）合并腹膜型内异症，47．3％（160／338）合并深部浸润型内异症。卵巢囊肿组患者中子宫表面病灶发生率（13．9％，47／338）、子宫直肠陷凹完全封闭率（38．5％，130／338）、骶韧带深部浸润结节发生率（40．5％，137／338）均高于非卵巢囊肿组的5．1％（4／78）、9．0％（7／78）、28．2％（22／78），差异均有统计学意义（P〈0．05）。（3）疼痛症状：两组患者痛经、大便痛等疼痛症状发生率及程度比较，差异均无统计学意义（P〉0．05），但卵巢囊肿组慢性盆腔痛（CPP）的发生率（24．6％，83／338）及性交痛的发生率（29．9％，101／338）均低于非卵巢囊肿组的35．9％（28／78）、44．9％（35／78），差异均有统计学意义（P〈0．05）。双侧卵巢内异症囊肿患者痛经的发生率（85．1％，114／134）高于单侧囊肿患者（74．0％，151／204），卵巢囊肿组伴中重度粘连患者的痛经发生率（89．0％，138／155）、大便痛发生率（18．7％，29／155）均明显高于卵巢囊肿组无粘连及轻度粘连的患者（分别为68．8％，126／183和8．2％，15／183）。卵巢囊肿组患者同时合并深部浸润型内异症时痛经、CPP、性交痛、肛门坠胀的发生风险均明显增加（OR值分别为5．17、3．01、3．05、2．75）。结论卵巢内异症囊肿常合并其他不同类型的盆腔内异症；卵巢内异症囊肿与内异症患者子宫表面病灶、子宫直肠陷凹封闭、骶韧带内异症结节关系密切；卵巢内异症囊肿同时合并深部浸润型内异症时各种疼痛发生风险明显增加。

Objective To study the relationship between the clinic-pathological features and pain symptoms in patients with endometriotic cyst （EM）. Methods The medical data of symptoms, laparoscopy and pathology examination in 416 patients with endometriosis were studied retrospectively. All cases were divided into two groups on the existence of ovarian endometrioma, including 338 patients in cyst group and 78 cases in non-cyst group. The relationship between clinical symptoms and location and type of endometrioma was studied. Results （ 1 ） Serum CA125 level ： the level of CA125 were （61 ± 39） kU/L in cyst group （ 28 ＋ 24 ） kU/L in non-cyst group, which reached statistical difference （ P 〈 0.01 ）. （ 2 ） Pathological features ：among 338 cases, 34.0% of cyst were on left side（ 115/338 ）, 26. 3 % were fight side（ 89/338 ）, and 39. 6% were on both side （ 134/338 ）. And 95.8% （ 324/338 ） of cases were combined with the othertype of endometriosis, which were 48. 5% （164/338） with peritoneal endometriosis, 47. 3% （160/338） with deep infiltrating endometriosis （DIE）. In cystic patients, the incidences of endometriosis lesion were 13.9% （47/338） on the uterine surface, 38. 5% （130/338） on obstruction of eul-de sac, 40. 5% （137/338） on utero-saeral ligament of DIE, which were significantly higher than 5. 1%, （4/78）, 9.0% （7/78） and 28. 2% （22/78） in noncyst group. （3） Pain symptom： the incidence and degree of dysmenorrhea and dyschezia had no statistical difference between two groups （ P 〉 0. 05 ）, and the incidence of chronic pelvic pain（CPP） of 24. 6% （83/338） and dyspareunia of 29. 9% （ 101/338 ） in the cyst group were significantly lower than 35.9% （ 28/78 ） and 44. 9% （ 35/78 ） in non-cyst group （ P 〈 0. 05 ）. The incidence of dysmenorrheal was 85. 1% （114/134） in cases with bilateral cyst, which was higher than 74. 0% （151/204） in cases with single cyst. The incidence of dysmenorrheal and dyschezia in moderate- severe adhesion was 89.0% （ 138/155 ） and 18.7% （29/155）, which was significantly higher than 68. 8% （126/183） and 8.2% （15/183） in mild adhesion. In the patients cyst existed with DIE, the risk of dysmenorrheal, CPP, dyspareunia, and dysehezia were obviously raised （OR respectively was 5. 17, 3.01, 3.05, 2. 75 ）. Conclusions The endometriotic cyst often co-exists with other type of endometriotic lesions. Ovarian endometrioma was associated with lesion localized on uterine surface, cul-de-sac, sacrum ligament. The risk of all the pain symptoms would be raised when the endometriotic cyst co-exit with the DIE lesions. So the treatment for DIE lesions was as same important as the endometriotie lesions in order to relieve pain symptoms and delay the relapse.