结肠镜检查在肠道子宫内膜异位症诊断检查中的作用。
Role of colonoscopy in the diagnostic work-up of bowel endometriosis.
作者信息
Milone Marco, Mollo Antonio, Musella Mario, Maietta Paola, Sosa Fernandez Loredana Maria, Shatalova Olena, Conforti Alessandro, Barone Gianni, De Placido Giuseppe, Milone Francesco
机构信息
Marco Milone, Mario Musella, Paola Maietta, Olena Shatalova, Gianni Barone, Francesco Milone, Department of Advanced Biomedical Science, University of Naples "Federico II", 80131 Naples, Italy.
出版信息
World J Gastroenterol. 2015 Apr 28;21(16):4997-5001. doi: 10.3748/wjg.v21.i16.4997.
AIM
To evaluate the accuracy of colonoscopy for the prediction of intestinal involvement in deep pelvic endometriosis.
METHODS
This prospective observational study was performed between September 2011 and July 2014. Only women with both a clinical and imaging diagnosis of deep pelvic endometriosis were included. The study was approved by the local ethics committee and written informed consent was obtained in all cases. Both colonoscopy and laparoscopy were performed by expert surgeons with a high level of expertise with these techniques. Laparoscopy was performed within 4 wk of colonoscopic examination. All hypothetical colonoscopy findings (eccentric wall thickening with or without surface nodularities and polypoid lesions with or without surface nodularities of endometriosis) were compared with laparoscopic and histological findings. We calculated the sensitivity, specificity, positive predictive value and negative predictive value for the presence of colonoscopic findings of intestinal endometriosis.
RESULTS
A total of 174 consecutive women aged between 21-42 years with a diagnosis of deep pelvic endometriosis who underwent colonoscopy and surgical intervention were included in our analysis. In 76 of the women (43.6%), intestinal endometrial implants were found at surgery and histopathological examination. Specifically, 38 of the 76 lesions (50%) were characterized by the presence of serosal bowel nodules; 28 of the 76 lesions (36.8%) reached the muscularis layer; 8 of the 76 lesions (10.5%) reached the submucosa; and 2 of the 76 lesions (2.6%) reached the mucosa. Colonoscopic findings suggestive of intestinal endometriosis were detected in 7 of the 174 (4%) examinations. Colonoscopy failed to diagnose intestinal endometriosis in 70 of the 76 women (92.1%). A colonoscopic diagnosis of endometriosis was obtained in all cases of mucosal involvement, in 3 of 8 cases (37.5%) of submucosal involvement, in no cases of muscularis layer involvement and in 1 of 38 cases (2.6%) of serosa involvement. The sensitivity, specificity, positive predictive and negative predictive values of colonoscopy for the diagnosis of intestinal endometriosis were 7%, 98%, 85% and 58%, respectively.
CONCLUSION
Being an invasive procedure, colonoscopy should not be routinely performed in the diagnostic work-up of bowel endometriosis.
目的
评估结肠镜检查预测深部盆腔子宫内膜异位症肠道受累情况的准确性。
方法
本前瞻性观察性研究于2011年9月至2014年7月进行。仅纳入临床及影像学诊断为深部盆腔子宫内膜异位症的女性。本研究经当地伦理委员会批准，所有病例均获得书面知情同意。结肠镜检查和腹腔镜检查均由精通这些技术的专家外科医生进行。腹腔镜检查在结肠镜检查后4周内进行。将所有假设的结肠镜检查结果（伴有或不伴有表面结节的偏心性肠壁增厚以及伴有或不伴有子宫内膜异位症表面结节的息肉样病变）与腹腔镜检查及组织学检查结果进行比较。我们计算了结肠镜检查发现肠道子宫内膜异位症的敏感性、特异性、阳性预测值和阴性预测值。
结果
共有174例年龄在21 - 42岁之间、诊断为深部盆腔子宫内膜异位症且接受了结肠镜检查和手术干预的连续女性纳入我们的分析。在76例女性（43.6%）中，手术及组织病理学检查发现肠道有子宫内膜种植。具体而言，76个病变中的38个（50%）表现为浆膜下肠结节；76个病变中的28个（36.8%）累及肌层；76个病变中的8个（10.5%）累及黏膜下层；76个病变中的2个（2.6%）累及黏膜。174例检查中有7例（4%）发现提示肠道子宫内膜异位症的结肠镜检查结果。76例女性中有70例（92.1%）结肠镜检查未能诊断出肠道子宫内膜异位症。所有黏膜受累病例均通过结肠镜诊断为子宫内膜异位症，8例黏膜下层受累病例中有3例（37.5%）诊断为子宫内膜异位症，肌层受累病例均未诊断出，38例浆膜受累病例中有1例（2.6%）诊断为子宫内膜异位症。结肠镜检查诊断肠道子宫内膜异位症的敏感性、特异性、阳性预测值和阴性预测值分别为7%、98%、85%和58%。
结论
作为一种侵入性检查，结肠镜检查不应常规用于肠道子宫内膜异位症的诊断评估。
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