Miller Emily J, Fraser Ian S
Department of Obstetrics, Gynaecology & Neonatology, Queen Elizabeth II Research Institute for Mothers & Infants, The University of Sydney, New South Wales, Australia.
School of Women's & Children's Health, University of New South Wales, Sydney, Australia.
Womens Health (Lond). 2015 Aug;11(5):611-8. doi: 10.2217/whe.15.47. Epub 2015 Aug 28.
Several lines of recent evidence suggest that pelvic innervation is altered in endometriosis-affected women, and there is a strong presumption that nerve fibers demonstrated in eutopic endometrium (of women with endometriosis) and in endometriotic lesions play roles in the generation of chronic pelvic pain. The recent observation of sensory C, sensory A-delta, sympathetic and parasympathetic nerve fibers in the functional layer of endometrium of most women affected by endometriosis, but not demonstrated in most women who do not have endometriosis, was a surprise. Nerve fiber densities were also greatly increased in myometrium of women with endometriosis and in endometriotic lesions compared with normal peritoneum. Chronic pelvic pain is complex, and endometriosis is only one condition which contributes to this pain. The relationship between the presence of certain nerve fibers and the potential for local pain generation requires much future research. This paper reviews current knowledge concerning nerve fibers in endometrium, myometrium and endometriotic lesions, and discusses avenues of research that may improve our knowledge and lead to enriched understanding and management of endometriotic pain symptoms.
最近有几条证据表明，子宫内膜异位症患者的盆腔神经支配发生了改变，并且有一个强烈的推测，即在（患有子宫内膜异位症的）女性的在位内膜以及子宫内膜异位病灶中显示出的神经纤维在慢性盆腔疼痛的产生中起作用。最近观察到，大多数受子宫内膜异位症影响的女性的子宫内膜功能层中存在感觉C神经纤维、感觉A-δ神经纤维、交感神经和副交感神经纤维，但大多数没有子宫内膜异位症的女性中未观察到，这令人惊讶。与正常腹膜相比，子宫内膜异位症患者的子宫肌层和子宫内膜异位病灶中的神经纤维密度也大大增加。慢性盆腔疼痛很复杂，子宫内膜异位症只是导致这种疼痛 的一种情况。某些神经纤维的存在与局部疼痛产生可能性之间的关系需要未来进行大量研究。本文综述了有关子宫内膜、子宫肌层和子宫内膜异位病灶中神经纤维的现有知识，并讨论了可能增进我们的了解并有助于更深入理解和管理子宫内膜异位症疼痛症状的研究途径。
