盆腔子宫内膜异位症疼痛症状与临床病理特征的关系

[Relationship between pain symptoms and clinico-pathological features of pelvic endometriosis].

作者信息

Leng Jin-hua, Lang Jing-he, Dai Yi, Li Hua-jun, Li Xiao-yan

机构信息

Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Science, Beijing 100730, China.

出版信息

Zhonghua Fu Chan Ke Za Zhi. 2007 Mar;42(3):165-8.

PMID:17537300

Abstract

OBJECTIVE

To study the relationship between pain symptoms and the clinico-pathological features of pelvic endometriosis (EM).

METHODS

One hundred thirty patients with laparoscopic diagnosis of EM were studied retrospectively and the relationship between pain symptoms including dysmenorrhea, chronic pelvic pain (CPP), dyspareunia and dyschezia and the anatomical features of pelvic endometriosis were evaluated.

RESULTS

One hundred (76.9%) patients with pain symptoms and 30 (23.1%) without were included in this study. The number of patients with mild, moderate and severe dysmenorrhoea was 27 (20.8%), 41 (31.5%), and 32 (24.6%), respectively. Patients with dyspareunia, CPP and dyschezia were 46 (35.4%), 45 (34.6%) and 67 (51.5%), respectively. Compared with patients without dysmenorrhea, the proportion of deep utero-sacral nodules (45.0% vs 13.3%, P=0.00), recto-vaginal nodules (16.0% vs 0, P=0.01), complete obliteration of cul-de sac (41.0% vs 10.0%, P=0.00), and lesions of DIE (51.0% vs 16.7%, P=0.00) was significantly increased in patients with dysmenorrhea. The severity of dysmenorrhea was positively correlated with nodules in uterosacral ligaments (P=0.005, r=0.302), and invasive depth of uterosacral ligaments (P=0.016, OR=5.085). Among patients with endometrioma, significantly more moderate to severe adhesions were found in patients with dysmenorrhea, compared with those patients without dysmenorrhea (29.1% vs 8.3%, P=0.029). Patients with CPP had more nodules in the utero-sacral ligaments (51.1% vs 30.6%, P=0.018) and DIE lesions (57.8% vs 35.3%, P=0.011), compared with those without. More nodules in the utero-sacral ligaments (46.3% vs 28.6%, P=0.028), recto-vaginal nodules (19.4% vs 4.8%, P=0.01), complete obliteration of cul-de sac (44.8% vs 22.2%, P=0.005) and DIE lesions (53.7% vs 31.7%, P=0.01) were found in patients with dyschezia, compared with those without. Nodules in the recto-vaginal pouch were an independent risk factor of dyspareunia.

CONCLUSION

Pain symptoms including dysmenorrhea, dyspareunia, chronic pelvic pain, and dyschezia are remarkably related to endometriotic nodules at the posterior part of the pelvis or those with deep invasions.

摘要

目的

研究疼痛症状与盆腔子宫内膜异位症（EM）临床病理特征之间的关系。

方法

回顾性研究130例经腹腔镜诊断为EM的患者，评估痛经、慢性盆腔疼痛（CPP）、性交痛和排便困难等疼痛症状与盆腔子宫内膜异位症解剖特征之间的关系。

结果

本研究纳入了100例（76.9%）有疼痛症状的患者和30例（23.1%）无疼痛症状的患者。轻度、中度和重度痛经患者的数量分别为27例（20.8%）、41例（31.5%）和32例（24.6%）。性交痛、CPP和排便困难的患者分别为46例（35.4%）、45例（34.6%）和67例（51.5%）。与无痛经患者相比，痛经患者深部子宫骶骨结节（45.0% 对13.3%，P = 0.00）、直肠阴道结节（16.0% 对0，P = 0.01）、直肠子宫陷凹完全闭塞（41.0% 对10.0%，P = 0.00）及深部浸润型子宫内膜异位症（DIE）病变（51.0% 对16.7%，P = 0.00）的比例显著增加。痛经的严重程度与子宫骶骨韧带结节（P = 0.005，r = 0.302）及子宫骶骨韧带浸润深度（P = 0.016，OR = 5.085）呈正相关。在子宫内膜瘤患者中，与无痛经患者相比，痛经患者中中重度粘连明显更多（29.1% 对8.3%，P = 0.029）。与无CPP患者相比，CPP患者子宫骶骨韧带结节更多（51.1% 对30.6%），P = 0.018），DIE病变更多（57.8% 对35.3%，P = 0.011）。与无排便困难患者相比，排便困难患者子宫骶骨韧带结节更多（46.3% 对28.6%，P = 0.028）、直肠阴道结节更多（19.4% 对4.8%，P = 0.01）、直肠子宫陷凹完全闭塞更多（44.8% 对22.2%，P = 0.005）及DIE病变更多（53.7% 对31.7%，P = 0.01）。直肠阴道陷凹结节是性交痛的独立危险因素。