Lessey Bruce A, Higdon H Lee, Miller Sara E, Price Thomas A
Department of Obstetrics and Gynecology, Division of Reproductive Endocrinology and Infertility, Greenville Hospital System.
J Vis Exp. 2012 Dec 21(70):4313. doi: 10.3791/4313.
Endometriosis is a common disease affecting 40 to 70% of reproductive-aged women with chronic pelvic pain (CPP) and/or infertility. The purpose of this study was to demonstrate the use of a blue dye (methylene blue) to stain peritoneal surfaces during laparoscopy (L/S) to detect the loss of peritoneal integrity in patients with pelvic pain and suspected endometriosis. Forty women with CPP and 5 women without pain were evaluated in this pilot study. During L/S, concentrated dye was sprayed onto peritoneal surfaces, then aspirated and rinsed with Lactated Ringers solution. Areas of localized dye uptake were evaluated for the presence of visible endometriotic lesions. Areas of intense peritoneal staining were resected and some fixed in 2.5% buffered gluteraldehyde and examined by scanning (SEM) electron microscopy. Blue dye uptake was more common in women with endometriosis and chronic pelvic pain than controls (85% vs. 40%). Resection of the blue stained areas revealed endometriosis by SEM and loss of peritoneal cell-cell contact compared to normal, non-staining peritoneum. Affected peritoneum was associated with visible endometriotic implants in most but not all patients. Subjective pain relief was reported in 80% of subjects. Based on scanning electron microscopy, we conclude that endometrial cells extend well beyond visible implants of endometriosis and appear to disrupt the underlying mesothelium. Subtle lesions of endometriosis could therefore cause pelvic pain by disruption of peritoneal integrity, allowing menstrual or ovulatory blood and associated pain factors access to underlying sensory nerves. Complete resection of affected peritoneum may provide a better long-term treatment for endometriosis and CPP. This simple technique appears to improve detection of subtle or near invisible endometriosis in women with CPP and minimal visual findings at L/S and may serve to elevate diagnostic accuracy for endometriosis at laparoscopy.
子宫内膜异位症是一种常见疾病，影响40%至70%有慢性盆腔疼痛（CPP）和/或不孕症的育龄妇女。本研究的目的是证明在腹腔镜检查（L/S）期间使用蓝色染料（亚甲蓝）对腹膜表面进行染色，以检测盆腔疼痛和疑似子宫内膜异位症患者的腹膜完整性丧失。在这项初步研究中，对40名患有CPP的女性和5名无疼痛的女性进行了评估。在L/S期间，将浓缩染料喷洒在腹膜表面，然后吸出并用乳酸林格氏液冲洗。评估局部染料摄取区域是否存在可见的子宫内膜异位病变。切除强烈腹膜染色区域，一些固定在2.5%缓冲戊二醛中，并用扫描（SEM）电子显微镜检查。与对照组相比，子宫内膜异位症和慢性盆腔疼痛女性的蓝色染料摄取更为常见（85%对40%）。切除蓝色染色区域后，通过SEM显示为子宫内膜异位症，与正常未染色的腹膜相比，腹膜细胞间接触丧失。在大多数但不是所有患者中，受影响的腹膜与可见的子宫内膜异位植入物相关。80%的受试者报告主观疼痛缓解。基于扫描电子显微镜，我们得出结论，子宫内膜细胞延伸到子宫内膜异位症可见植入物之外，似乎破坏了下层间皮。因此，子宫内膜异位症的微小病变可能通过破坏腹膜完整性导致盆腔疼痛，使月经或排卵血液及相关疼痛因子接触下层感觉神经。完全切除受影响的腹膜可能为子宫内膜异位症和CPP提供更好的长期治疗。这种简单技术似乎可以提高对CPP女性中微小或几乎不可见的子宫内膜异位症的检测，这些女性在L/S时视觉发现最少，并且可能有助于提高腹腔镜检查时子宫内膜异位症的诊断准确性。
