前灶性腺肌病与膀胱深部浸润性子宫内膜异位症：是否存在关联？

Anterior Focal Adenomyosis and Bladder Deep Infiltrating Endometriosis: Is There a Link?

机构信息

Université Paris Descartes, Sorbonne Paris Cité, Faculté de Médecine, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Universitaire Paris Centre (HUPC), Centre Hospitalier Universitaire (CHU) Cochin, Department of Gynaecology Obstetrics II and Reproductive Medicine, Paris, France; Department of Development, Reproduction and Cancer, Institut Cochin, INSERM U1016, Université Paris Descartes, Sorbonne Paris Cité, Paris, France.

Université Paris Descartes, Sorbonne Paris Cité, Faculté de Médecine, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Universitaire Paris Centre (HUPC), Centre Hospitalier Universitaire (CHU) Cochin, Department of Gynaecology Obstetrics II and Reproductive Medicine, Paris, France; Gynecology & Physiopathology of Human Reproduction Unit, Sant'Orsola-Malpighi Hospital, Bologna, Italy.

出版信息

J Minim Invasive Gynecol. 2018 Jul-Aug;25(5):896-901. doi: 10.1016/j.jmig.2018.02.002. Epub 2018 Feb 9.

DOI:10.1016/j.jmig.2018.02.002

PMID:29432902

Abstract

STUDY OBJECTIVE

To evaluate the association between bladder deep infiltrating endometriosis (DIE) and anterior focal adenomyosis of the outer myometrium (aFAOM) diagnosed by preoperative magnetic resonance imaging (MRI).

DESIGN

An observational, cross-sectional study using prospectively collected data (Canadian Task Force classification II-2).

SETTING

Single university tertiary referral center.

PATIENTS

All nonpregnant women younger than 42 years who had undergone complete surgical exeresis of endometriotic lesions. For each patient a standardized questionnaire was completed during a face-to-face interview conducted by the surgeon during the month preceding the surgery. Only women with preoperative standardized uterine MRI were retained for this study.

INTERVENTIONS

Thirty-nine women with histologically proven bladder DIE and an available preoperative MRI were enrolled in the study. Patients were divided into 2 groups: women with aFAOM (aFAOM (+), n = 19) and women without aFAOM (aFAOM (-), n = 20). Both groups were compared for general characteristics, medical history, MRI findings, and disease severity.

MEASUREMENTS AND MAIN RESULTS

Nineteen patients (48.7%) with bladder DIE had aFAOM at preoperative MRI. The rate of associated diffuse adenomyosis was similar in the 2 groups (63.2% [n = 12] vs 73.7% [n = 14]; p = .48). The rate of an associated ovarian endometrioma (OMA) was significantly lower in the aFAOM (+) group (10.5% [n = 2] vs 40.0% [n = 8]; p = .03). There were fewer associated intestinal DIE lesions in the aFAOM (+) group compared with the aFAOM (-) group (26.3% vs 75.0%; p = .02), with lower involvement of the pouch of Douglas (26.3% vs 70%; p < .01). Total American Society for Reproductive Medicine score was significantly lower in the aFAOM (+) group (13.8 ± 12.2 vs 62.2 ± 46.2; p < .01).

CONCLUSION

aFAOM is present in only half of women with bladder DIE and appears to be associated with lower associated posterior DIE.

摘要

研究目的

评估术前磁共振成像（MRI）诊断的膀胱深部浸润性子宫内膜异位症（DIE）和外肌层前局灶性腺肌症（aFAOM）之间的关联。

设计

使用前瞻性收集的数据进行的观察性、横断面研究（加拿大任务组分类 II-2）。

设置

单所大学三级转诊中心。

患者

所有年龄小于 42 岁且接受过子宫内膜异位症病变完全手术切除的非孕妇。每位患者在手术前一个月由外科医生进行面对面访谈时完成一份标准化问卷。仅对有术前标准化子宫 MRI 的女性进行这项研究。

干预措施

39 名经组织学证实的膀胱 DIE 且有术前 MRI 的患者入组本研究。患者分为 2 组：aFAOM 患者（aFAOM（+），n=19）和无 aFAOM 患者（aFAOM（-），n=20）。比较两组的一般特征、病史、MRI 发现和疾病严重程度。

测量和主要结果

19 名（48.7%）患有膀胱 DIE 的患者在术前 MRI 上有 aFAOM。两组弥漫性腺肌症的发生率相似（63.2%[n=12]与 73.7%[n=14]；p=0.48）。aFAOM（+）组的卵巢子宫内膜异位囊肿（OMA）发生率明显较低（10.5%[n=2]与 40.0%[n=8]；p=0.03）。与 aFAOM（-）组相比，aFAOM（+）组的肠子宫内膜异位症病变较少（26.3%与 75.0%；p=0.02），Douglas 袋受累较低（26.3%与 70%；p<0.01）。aFAOM（+）组的美国生殖医学协会总评分明显较低（13.8±12.2 与 62.2±46.2；p<0.01）。