Ishimura T, Masuzaki H
Department of Obstetrics and Gynecology, School of Medicine, Nagasaki University, Japan.
Am J Obstet Gynecol. 1991 Jul;165(1):210-4. doi: 10.1016/0002-9378(91)90253-n.
The mechanisms involved in primary implantation of pelvic endometriosis were investigated in women undergoing laparoscopy as part of an infertility evaluation. Among the women with a diagnosis of endometriosis, those with no observed lesions in the ovaries and no adhesions in the pelvic cavity were classified as being in stage I. These women were further subdivided into two groups: the stage Ia group in which implants were found in one area (25 women) and the stage Ib group in which implants were found in two or more areas (29 women). In both groups the most frequent site was the uterosacral ligaments followed by the posterior uterine serosa, the posterior cul-de-sac, and the posterior broad ligaments in that order. Regardless of the position of the uterus, endometriosis was found significantly more frequently in the posterior compartment. The finding that the most frequent implants on the uterosacral ligaments were near the tubal ostium and, in the stage Ia group, the absence of implants on the anterior uterine serosa but a 33% frequency on the posterior uterine serosa, which is more frequently exposed to menstrual blood, suggest that implantation of endometriosis is the result of retrograde menstruation. However, the possibility that metaplasia of the serosal epithelium is stimulated by menstrual blood cannot be ruled out, inasmuch as the process of implantation in the peritoneum has not yet been proved.
作为不孕症评估的一部分，对接受腹腔镜检查的女性进行了盆腔子宫内膜异位症初次植入机制的研究。在诊断为子宫内膜异位症的女性中，卵巢未观察到病变且盆腔无粘连的女性被归类为I期。这些女性进一步分为两组：Ia期组，在一个区域发现植入物（25名女性）；Ib期组，在两个或更多区域发现植入物（29名女性）。两组中最常见的部位依次是子宫骶韧带、子宫后浆膜、直肠子宫陷凹和阔韧带后叶。无论子宫位置如何，子宫内膜异位症在后盆腔的发生率明显更高。子宫骶韧带上最常见的植入物靠近输卵管开口，在Ia期组中，子宫前浆膜未发现植入物，但子宫后浆膜的发生率为33%，后者更易接触经血，这一发现表明子宫内膜异位症的植入是逆行月经的结果。然而，由于腹膜植入过程尚未得到证实，不能排除经血刺激浆膜上皮化生的可能性。
