Fauconnier A, Chapron C
Unité Inserm 149, Recherches Epidémiologiques en Santé Périnatale et Santé des Femmes, Port-Royal, Paris, France.
Hum Reprod Update. 2005 Nov-Dec;11(6):595-606. doi: 10.1093/humupd/dmi029. Epub 2005 Sep 19.
The relationship between chronic pelvic pain symptoms and endometriosis is unclear because painful symptoms are frequent in women without this pathology, and because asymptomatic forms of endometriosis exist. Our comprehensive review attempts to clarify the links between the characteristics of lesions and the semiology of chronic pelvic pain symptoms. Based on randomized trials against placebo, endometriosis appears to be responsible for chronic pelvic pain symptoms in more than half of confirmed cases. A causal association between severe dysmenorrhoea and endometriosis is very probable. This association is independent of the macroscopic type of the lesions or their anatomical locations and may be related to recurrent cyclic micro-bleeding in the implants. Endometriosis-related adhesions may also cause severe dysmenorrhoea. There are histological and physiopathological arguments for the responsibility of deeply infiltrating endometriosis (DIE) in severe chronic pelvic pain symptoms. DIE-related pain may be in relation with compression or infiltration of nerves in the sub-peritoneal pelvic space by the implants. The painful symptoms caused by DIE present particular characteristics, being specific to involvement of precise anatomical locations (severe deep dyspareunia, painful defecation) or organs (functional urinary tract signs, bowel signs). They can thus be described as location indicating pain. A precise semiological analysis of the chronic pelvic pain symptoms characteristics is useful for the diagnosis and therapeutic management of endometriosis in a context of pain.
慢性盆腔疼痛症状与子宫内膜异位症之间的关系尚不清楚，这是因为在没有这种病理状况的女性中疼痛症状很常见，而且还存在无症状形式的子宫内膜异位症。我们的综合综述试图阐明病变特征与慢性盆腔疼痛症状的症状学之间的联系。基于针对安慰剂的随机试验，在超过一半的确诊病例中，子宫内膜异位症似乎是慢性盆腔疼痛症状的病因。严重痛经与子宫内膜异位症之间很可能存在因果关联。这种关联独立于病变的宏观类型或其解剖位置，可能与植入物中反复的周期性微出血有关。与子宫内膜异位症相关的粘连也可能导致严重痛经。对于深部浸润性子宫内膜异位症（DIE）导致严重慢性盆腔疼痛症状，存在组织学和生理病理学依据。与DIE相关的疼痛可能与植入物对盆腔腹膜下空间神经的压迫或浸润有关。由DIE引起的疼痛症状具有特殊特征，特定于精确解剖位置（严重深部性交困难、排便疼痛）或器官（功能性尿路症状、肠道症状）的受累情况。因此，它们可被描述为具有定位指示性的疼痛。对慢性盆腔疼痛症状特征进行精确的症状学分析，对于在疼痛背景下子宫内膜异位症的诊断和治疗管理很有用。
