Hao Min, Zhao Wei-hong, Wang Yong-hong
Department of Obstetrics and Gynecology, Second Hospital of Shanxi Medical University, Taiyuan 030001, China.
Zhonghua Fu Chan Ke Za Zhi. 2009 May;44(5):333-6.
To study the incidence of pelvic adhesions in endometriosis (EM) and the relationship between pelvic adhesions and pain symptoms.
The incidence of pelvic adhesions, dysmenorrhea, chronic pelvic pain, dyspareunia, dyschizia in 480 patients with EM were studied retrospectively to evaluate the correlation between pelvic adhesions and the degree of pain symptoms. In accordance with the revised American Fertility Society classification (r-AFS), it was observed that 155 cases were in Stage I, 33 cases were in stage II, 108 cases were in stage III and 184 were cases in stage IV.
(1) Among 480 cases with EM, 72.3% (347/480) of patients have pelvic adhesions simultaneously, of which 25.2% (39/155) patients were in Stage I, 78.8% (26/33) patients were in Stage II, 90.7% (98/108) patients were in Stage III and 100.0% (184/184) patients were in Stage IV. It was found that positive correlation existed between the degree of pelvic adhesions and clinical staging of EM (r(s) = 0.870, P < 0.01). (2) 61.0% (293/480) of patients presented dysmenorrhoea, of which the percentages of mild, moderate and severe dysmenorrhea were 52.2% (153/293), 26.6% (78/293), 21.2% (62/293), respectively. The rate of patients presenting chronic pelvic pain (CPP), dyspareunia and dyschezia were 23.8% (114/480), 15.4% (74/480) and 7.1% (34/480), respectively. (3) Ovarian adhesions was positively correlated with dysmenorrhea and CPP (r(s) = 0.367 and 0.267, P < 0.01). Adhesion of the bottom and posterior wall of uterus was positively correlated with dysmenorrhea and CPP (r(s) = 0.336, 0.164, P < 0.01); adhesions of fallopian tubes were positively correlated with dysmenorrhea, CPP and dyschezia (r(s) = 0.283, 0.225 and 0.159, P < 0.01). Adhesions of rectum was positively correlated with dysmenorrhea (r(s) = 0.101, P < 0.05). In addition to dyspareunia, the degree of pelvic adhesions was positively correlated with dysmenorrhea, CPP and dyschezia (r(s) = 0.470, 0.273, 0.132, P < 0.01).
Pelvic adhesions are characteristic lesions of endometriosis, the site and degree pelvic adhesions are closely correlated with pain symptoms.
研究子宫内膜异位症（EM）盆腔粘连的发生率以及盆腔粘连与疼痛症状之间的关系。
回顾性研究480例EM患者盆腔粘连、痛经、慢性盆腔痛、性交困难、排便困难的发生率，以评估盆腔粘连与疼痛症状程度之间的相关性。按照修订的美国生育协会分类法（r-AFS），观察到Ⅰ期155例，Ⅱ期33例，Ⅲ期108例，Ⅳ期184例。
（1）480例EM患者中，72.3%（347/480）的患者同时存在盆腔粘连，其中Ⅰ期患者中25.2%（39/155）存在盆腔粘连，Ⅱ期患者中78.8%（26/33）存在盆腔粘连，Ⅲ期患者中90.7%（98/108）存在盆腔粘连，Ⅳ期患者中100.0%（184/184）存在盆腔粘连。发现盆腔粘连程度与EM临床分期呈正相关（r(s)=0.870，P<0.01）。（2）61.0%（293/480）的患者出现痛经，其中轻度、中度和重度痛经的比例分别为52.2%（153/293）、26.6%（78/293）、21.2%（62/293）。出现慢性盆腔痛（CPP）、性交困难和排便困难的患者比例分别为23.8%（114/480）、15.4%（74/480）和7.1%（34/480）。（3）卵巢粘连与痛经和CPP呈正相关（r(s)=0.367和0.267，P<0.01）。子宫底和后壁粘连与痛经和CPP呈正相关（r(s)=0.336，0.164，P<0.01）；输卵管粘连与痛经、CPP和排便困难呈正相关（r(s)=0.283，0.225和0.159，P<0.01）。直肠粘连与痛经呈正相关（r(s)=0.101，P<0.05）。除性交困难外，盆腔粘连程度与痛经、CPP和排便困难呈正相关（r(s)=0.470，0.273，0.132，P<0.01）。
盆腔粘连是子宫内膜异位症的特征性病变，盆腔粘连的部位和程度与疼痛症状密切相关。
