Leuven University Fertility Center, Department of Obstetrics & Gynaecology, University Hospital Leuven, Herestraat 49, Leuven 3000, Belgium.
Hum Reprod Update. 2013 Sep-Oct;19(5):570-82. doi: 10.1093/humupd/dmt016. Epub 2013 May 31.
BACKGROUND Endometriosis associated with pain symptoms in adolescents has been extensively reported, but the exact prevalence is unclear because pain symptoms may be atypical and endometriosis can only be diagnosed by laparoscopy. The aim of this paper is to provide a systematic review of the prevalence of endometriosis diagnosed by laparoscopy in adolescents. METHODS A systematic literature search was carried out for relevant articles published between 1980 and 2011 in the databases PUBMED and EMBASE, based on the keywords 'endometriosis', 'laparoscopy', 'adolescents' and 'chronic pelvic pain (CPP)'. In addition, the reference lists of the selected articles were examined. RESULTS Based on 15 selected studies, the overall prevalence of visually confirmed endometriosis was 62% (543/880; range 25-100%) in all adolescent girls undergoing laparoscopic investigation, 75% (237/314) in girls with CPP resistant to treatment, 70% (102/146) in girls with dysmenorrhea and 49% (204/420) in girls with CPP that is not necessarily resistant to treatment. Among the adolescent girls with endometriosis, the overall prevalence of American Society of Reproductive Medicine classified moderate-severe endometriosis was 32% (82/259) in all girls, 16% (17/108) in girls with CPP resistant to treatment, 29% (21/74) in girls with dysmenorrhea and 57% (44/77) in girls with CPP that is not necessarily resistant to treatment. Due to the quality of the included papers an overestimation of the prevalence and/or severity of endometriosis is possible. CONCLUSIONS About two-thirds of adolescent girls with CPP or dysmenorrhea have laparoscopic evidence of endometriosis. About one-third of these adolescents with endometriosis have moderate-severe disease. The value of early detection of endometriosis in symptomatic adolescents and the indications for laparoscopic investigation in adolescents require more research.
子宫内膜异位症与青少年疼痛症状有关，已有大量报道，但确切的患病率尚不清楚，因为疼痛症状可能不典型，且只有通过腹腔镜检查才能诊断子宫内膜异位症。本文旨在对腹腔镜检查诊断的青少年子宫内膜异位症的患病率进行系统综述。
对 1980 年至 2011 年间在 PUBMED 和 EMBASE 数据库中发表的相关文章进行了系统的文献检索，使用的关键词为“子宫内膜异位症”、“腹腔镜”、“青少年”和“慢性盆腔痛（CPP）”。此外，还检查了所选文章的参考文献列表。
基于 15 项选定的研究，所有接受腹腔镜检查的青春期少女中，肉眼可见的子宫内膜异位症总患病率为 62%（543/880；范围 25-100%），在对治疗有抵抗的 CPP 少女中为 75%（237/314），在痛经少女中为 70%（102/146），在不一定对治疗有抵抗的 CPP 少女中为 49%（204/420）。在患有子宫内膜异位症的青春期少女中，美国生殖医学学会分类的中重度子宫内膜异位症总患病率在所有少女中为 32%（82/259），在对治疗有抵抗的 CPP 少女中为 16%（17/108），在痛经少女中为 29%（21/74），在不一定对治疗有抵抗的 CPP 少女中为 57%（44/77）。由于纳入文献的质量，可能存在对子宫内膜异位症患病率和/或严重程度的高估。
大约三分之二的 CPP 或痛经的青春期少女有腹腔镜下子宫内膜异位症的证据。这些患有子宫内膜异位症的少女中约有三分之一患有中重度疾病。对有症状的青春期少女进行早期检测子宫内膜异位症和对青春期少女进行腹腔镜检查的适应证需要进一步研究。
