Quinn Martin
Department of Gynaecology, Hope Hospital, Stott Lane, Salford, Manchester M6 8HD, UK.
Med Hypotheses. 2004;63(4):602-8. doi: 10.1016/j.mehy.2004.03.032.
Endometriosis describes endometrium found outside the uterine cavity and is frequently associated with clinical presentations of chronic pelvic pain, dysmenorrhoea, dyspareunia and subfertility. It was originally attributed to retrograde menstruation with endometrium passing in a reverse direction along the Fallopian tubes into the peritoneal cavity though this theory does not account for the spectrum of intrapelvic findings. Denervation followed by reinnervation in the uterine isthmus is proposed as the primary source of clinical symptoms, and, retrograde menstruation with adhesion of endometrium to injured tissue surfaces the variable laparoscopic findings. Primary sources of denervation are difficult intrapartum episodes (parous women) and persistent straining to achieve defaecation (nulliparous women). Progressive reinnervation including stromal nerve fibre proliferation, microneuroma formation and periarterial nerve fibre proliferation, takes place over five to ten years. Damage to uterine innervation interrupts normal patterns of uterine contractility, causing loss of fundocervical polarity which promotes retrograde menstruation. Ectopic endometrium may be a marker for prior tissue damage and does not contribute to the clinical symptoms--the disease may have been largely defined by an epiphenomenon.
子宫内膜异位症是指子宫腔外出现的子宫内膜组织，常伴有慢性盆腔疼痛、痛经、性交困难和生育力低下等临床表现。该病最初被认为是由于月经逆行，子宫内膜沿输卵管逆向进入腹腔所致，不过这一理论无法解释盆腔内的所有发现。有观点认为，子宫峡部的去神经化及随后的再神经化是临床症状的主要来源，而月经逆行以及子宫内膜黏附于受损组织表面则导致了腹腔镜检查结果的多样性。去神经化的主要原因包括分娩时的难产（经产妇）和持续用力排便（未产妇）。渐进性再神经化过程，包括基质神经纤维增生、微神经瘤形成和动脉周围神经纤维增生，会在五到十年内发生。子宫神经支配受损会中断子宫正常的收缩模式，导致宫底-宫颈极性丧失，进而促进月经逆行。异位子宫内膜可能是先前组织损伤的一个标志，但其本身并非导致临床症状的原因——这种疾病很大程度上可能是由一种附带现象所定义的。
