Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Peking Union Medical College & Chinese Academy of Medical Science, Beijing 100730, China.
Chin Med J (Engl). 2012 Jan;125(2):209-13.
Endometriosis is a controversial and enigmatic disease. Deep infiltrating endometriosis (DIE) is responsible for painful symptoms and is the least understood type of endometriosis. Little work has been devoted to define the location of DIE lesions and its relationships with pain. The aim of the study was to investigate the relationship between the anatomical distribution of DIE lesions and pain symptoms.
Clinical data from 354 patients between May 2003 and December 2007 with laparoscopically diagnosed endometriosis were collected including 177 DIE patients and 177 non-DIE patients. The pain symptoms, including dysmenorrhea (DM), chronic pelvic pain (CPP, defined as intermittent or permanent pelvic pain, not related to the menstruation and longer than 6 months), deep dyspareunia (pelvic pain at intercourse) and dyschezia (pelvic pain with defecation), were recorded for every patient before operation. Endometriotic lesions were recorded by their anatomical distributions, the depth of infiltration and lesion colors. And the relationship between the anatomical distribution of DIE lesions and pain symptoms was analyzed. Pearson's chi-square test or Fisher's exact test, one-way analysis of variance (ANOVA) and linear regression and binary Logistic regression were used for statistical analysis.
The duration ((13.79 ± 3.94) years) of pain suffering in DIE patients was much longer than that of non-DIE patients (P < 0.01). In DIE patients, 60.7% of the uterosacral ligament (USL) nodules were bilateral (P < 0.01); 44.6% of the cul-de-sacs were completely blocked. Rectum invasion was observed in 19.9% of DIE patients (P = 0.03); pelvic adhesion was also more common. Up to 98.41% of the deep infiltrative lesions were located in the posterior pelvic compartment. DIE lesions were also found in bladder (1.58%), USL (67.08%), cul-de-sac (12.02%), recto-vaginal septum (12.66%), rectum and rectosigmoid junction (2.85%) and ureter (3.80%). The odds ratio of USL-DIE for CPP, deep dyspareunia, dyschezia were 2.52, 1.29 and 2.24 respectively. And the depth of infiltration correlated with the severity of dysmenorrhea.
DIE lesions were associated with severe pain symptoms. The main distribution of DIE lesions was in the posterior pelvic compartment, and was more widespread and severe in DIE patients. Moreover, resection of these DIE lesions are very important to treat the pain symptoms.
子宫内膜异位症是一种有争议且神秘的疾病。深部浸润型子宫内膜异位症（DIE）是导致疼痛症状的原因，也是最不被理解的一种子宫内膜异位症类型。很少有研究致力于定义 DIE 病变的位置及其与疼痛的关系。本研究旨在探讨 DIE 病变的解剖分布与疼痛症状之间的关系。
收集了 2003 年 5 月至 2007 年 12 月期间经腹腔镜诊断为子宫内膜异位症的 354 例患者的临床资料，包括 177 例 DIE 患者和 177 例非 DIE 患者。记录每位患者手术前的疼痛症状，包括痛经（DM）、慢性盆腔痛（CPP，定义为间歇性或持续性盆腔痛，与月经无关且持续时间超过 6 个月）、深部性交痛（性交时的盆腔痛）和排便困难（排便时的盆腔痛）。记录子宫内膜异位症病变的解剖分布、浸润深度和病变颜色。分析 DIE 病变的解剖分布与疼痛症状之间的关系。采用 Pearson χ²检验或 Fisher 确切概率检验、单因素方差分析（ANOVA）和线性回归以及二项 Logistic 回归进行统计分析。
DIE 患者疼痛持续时间（（13.79±3.94）年）明显长于非 DIE 患者（P＜0.01）。在 DIE 患者中，60.7%的宫骶韧带（USL）结节为双侧（P＜0.01）；44.6%的子宫直肠窝完全阻塞。直肠侵犯在 19.9%的 DIE 患者中观察到（P=0.03）；盆腔粘连也更为常见。高达 98.41%的深部浸润性病变位于骨盆后腔。DIE 病变还见于膀胱（1.58%）、USL（67.08%）、子宫直肠窝（12.02%）、直肠阴道隔（12.66%）、直肠和直肠乙状结肠交界处（2.85%）和输尿管（3.80%）。USL-DIE 发生 CPP、深部性交痛和排便困难的优势比分别为 2.52、1.29 和 2.24。浸润深度与痛经严重程度相关。
DIE 病变与严重疼痛症状相关。DIE 病变的主要分布在骨盆后腔，在 DIE 患者中更为广泛和严重。此外，切除这些 DIE 病变对治疗疼痛症状非常重要。
