Gynaecology and Human Reproduction Physiopathology, DIMEC, S. Orsola Hospital, University of Bologna, Bologna, Italy.
Department of Obstetrics and Gynecology, Faculty of Medicine, University of Alexandria, Alexandria, Egypt.
Ultrasound Obstet Gynecol. 2018 Aug;52(2):265-268. doi: 10.1002/uog.18924. Epub 2018 Jun 25.
Previous studies comparing women with deep infiltrating endometriosis (DIE) and healthy controls have underlined an association between pelvic floor muscle (PFM) hypertonic dysfunction and deep lesions. The aim of this study was to compare the morphometry of PFM in women affected by ovarian endometriosis with DIE vs those without DIE in order to assess the impact of retroperitoneal infiltration by the disease on PFM function.
This was a prospective study conducted between March 2015 and December 2016 on symptomatic women with a clinical and sonographic diagnosis of ovarian endometriosis with or without DIE, scheduled for laparoscopic surgery. We excluded patients with current or previous pregnancy, previous surgery for deep endometriosis, other causes of chronic pelvic pain or congenital or acquired abnormalities of pelvic floor anatomy. Three- and four-dimensional transperineal ultrasound was performed to evaluate PFM morphometry and assess levator hiatal area (LHA) and diameters at rest, during PFM contraction and during Valsalva maneuver. All volumes were analyzed offline by an investigator blinded to the clinical data.
One hundred and fourteen patients with ovarian endometriosis were enrolled in the study, 75 with DIE and 39 without DIE. The diagnosis of endometriosis was confirmed by histological examination in all patients. Compared with women without DIE, women with DIE showed a smaller LHA at rest, during contraction and during Valsalva maneuver (P = 0.03, P = 0.03 and P = 0.02, respectively) and a smaller reduction in LHA during PFM contraction (P = 0.04).
Women with ovarian endometriosis who were affected by DIE showed smaller hiatal dimensions than did women without DIE. Considering that PFM dysfunction in patients with DIE could cause pain symptoms and pelvic organ dysfunction, transperineal ultrasound could allow a more complete functional assessment and tailored therapy. Copyright © 2017 ISUOG. Published by John Wiley & Sons Ltd.
先前比较患有深部浸润型子宫内膜异位症（DIE）和健康对照组女性的研究强调了盆底肌（PFM）张力障碍与深部病变之间的关联。本研究旨在比较患有卵巢子宫内膜异位症合并 DIE 与不合并 DIE 的女性的 PFM 形态，以评估疾病对 PFM 功能的腹膜后浸润的影响。
这是一项前瞻性研究，于 2015 年 3 月至 2016 年 12 月在因卵巢子宫内膜异位症而有临床和超声诊断、并计划接受腹腔镜手术的有症状女性中进行。我们排除了当前或以前妊娠、深部子宫内膜异位症既往手术、其他慢性盆腔疼痛原因或盆底解剖结构先天性或获得性异常的患者。对所有患者进行经会阴三维和四维超声检查，以评估 PFM 形态并评估静息时、收缩时和 Valsalva 动作时的肛提肌裂孔面积（LHA）和直径。所有体积均由一名对临床数据不知情的研究者离线分析。
共有 114 例卵巢子宫内膜异位症患者入组本研究，其中 75 例合并 DIE，39 例不合并 DIE。所有患者均通过组织学检查确诊为子宫内膜异位症。与不合并 DIE 的女性相比，合并 DIE 的女性在静息时、收缩时和 Valsalva 动作时的 LHA 更小（P=0.03、P=0.03 和 P=0.02），收缩时 LHA 减少更小（P=0.04）。
患有卵巢子宫内膜异位症合并 DIE 的女性的裂孔尺寸小于不合并 DIE 的女性。考虑到 DIE 患者的 PFM 功能障碍可能导致疼痛症状和盆腔器官功能障碍，经会阴超声检查可能可以进行更全面的功能评估和针对性治疗。版权所有 © 2017 ISUOG。由 John Wiley & Sons Ltd 出版。
