Vercellini Paolo, Chapron Charles, Fedele Luigi, Frontino Giada, Zaina Barbara, Crosignani Pier Giorgio
First Department of Obstetrics and Gynecology, University of Milano, Milan, Italy.
Obstet Gynecol. 2003 Aug;102(2):383-7. doi: 10.1016/s0029-7844(03)00532-5.
To investigate if a lateral asymmetry exists in the distribution of endometriotic lesions of the sciatic nerve.
All articles on sciatic nerve endometriosis identified by MEDLINE and EMBASE database searches were retrieved, and additional reports were collected by systematically reviewing all references. Monographs on endometriosis published in the last 15 years were consulted.
We considered articles in which the presence of an endometriotic lesion of the sciatic nerve and the affected side were assessed. We also included reports lacking histological examination of sciatic nerve specimens but with a surgical diagnosis of pelvic endometriosis. Two authors abstracted data independently on standardized forms. The number of women and the side of the lesion were obtained from individual studies, and the combined frequency of left- and right-side sciatic nerve endometriosis in published reports was computed.
TABULATION, INTEGRATION, AND RESULTS: Thirty-two reports including 63 subjects were selected. Endometriosis of the sciatic nerve was on the right side in 41 patients, on the left in 20, and bilateral in two. Considering only patients with unilateral sciatic nerve endometriosis, the observed proportion of right-side lesions (41 of 61 [67.2%]; 95% confidence interval 54.0%, 78.7%) significantly differed from the expected proportion of 50% (chi(2)(1) 7.23, P =.007). Among the 16 cases of histological demonstration of endometriosis infiltrating sciatic nerve roots or fibers, ten had it on the right side (62.5%) and six on the left. Twenty-six of the 38 subjects (68.4%) with surgical demonstration of pelvic endometriosis but without histopathologic evidence of direct sciatic nerve involvement were affected by right cyclic sciatica.
The finding that two thirds of patients with sciatic nerve endometriosis had right-side lesions constitutes further evidence against the coelomic metaplasia theory. The interposition of the sigmoid colon between the regurgitated endometrial cells implanted on the left posterolateral pelvic peritoneum seems to protect the left lumbosacral plexus and sciatic nerve.
探讨坐骨神经子宫内膜异位症病变分布是否存在侧别不对称。
检索MEDLINE和EMBASE数据库中所有关于坐骨神经子宫内膜异位症的文章，并通过系统回顾所有参考文献收集其他报告。查阅了过去15年出版的子宫内膜异位症专著。
我们纳入了评估了坐骨神经子宫内膜异位症病变存在情况及患侧的文章。我们还纳入了缺乏坐骨神经标本组织学检查但有盆腔子宫内膜异位症手术诊断的报告。两位作者独立地在标准化表格上提取数据。从个体研究中获取女性数量和病变侧别，并计算已发表报告中左侧和右侧坐骨神经子宫内膜异位症的合并频率。
制表、整合及结果：选择了32篇报告，包括63名受试者。坐骨神经子宫内膜异位症右侧有41例患者，左侧有20例，双侧有2例。仅考虑单侧坐骨神经子宫内膜异位症患者，观察到的右侧病变比例（61例中的41例[67.2%]；95%置信区间54.0%，78.7%）与预期的50%比例有显著差异（χ(2)(1) 7.23，P = 0.007）。在16例组织学证实子宫内膜异位症浸润坐骨神经根或神经纤维的病例中，右侧有10例（62.5%），左侧有6例。38名有盆腔子宫内膜异位症手术证据但无坐骨神经直接受累组织病理学证据的受试者中，26例（68.4%）受右侧周期性坐骨神经痛影响。
三分之二的坐骨神经子宫内膜异位症患者病变在右侧这一发现进一步证明了反对体腔上皮化生理论。植入左后外侧盆腔腹膜的反流子宫内膜细胞之间乙状结肠的插入似乎保护了左腰骶丛和坐骨神经。
