Reis Fernando M, Santulli Pietro, Marcellin Louis, Borghese Bruno, Lafay-Pillet Marie-Christine, Chapron Charles
Department of Gynecology Obstetrics II and Reproductive Medicine (Professor Chapron), Faculté de Médecine, Université Paris Descartes, Sorbonne Paris Cité; and Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Universitaire Paris Centre (HUPC), Centre Hospitalier Universitaire (CHU) Cochin, Paris, France.
Department of Obstetrics and Gynecology, University of Minas Gerais, and National Institute of Hormones and Women's Health, Belo Horizonte, Brazil.
Reprod Sci. 2020 Jan;27(1):309-315. doi: 10.1007/s43032-019-00028-1. Epub 2020 Jan 1.
The aim of this study was to characterize a large sample of women with superficial peritoneal endometriosis (SUP) and no other types of endometriosis in order to test the association of SUP with gynecologic symptoms. We included 203 cases of histologically proven SUP and 1292 endometriosis-free controls diagnosed between January 2004 and July 2017. The participants were non-pregnant patients aged 18 to 42 years submitted to a laparoscopy or laparotomy for a benign gynecologic condition. We excluded all cases of ovarian endometrioma, deep infiltrating endometriosis, and women who had previously undergone an endometriosis surgery. All patients underwent face-to-face interviews, thorough preoperative physical examination, and transvaginal ultrasound. Pain severity was assessed preoperatively through an 11-point numerical rating scale. The association of SUP with gynecologic symptoms was adjusted for potential confounders using multivariable logistic regression. The presence of SUP was associated with lower body weight (59.8 vs. 63.5 kg) and body mass index (21.8 vs. 23.3 kg/m), and a higher frequency of smoking habit (41.6% vs. 32.8%) and of positive familial history of endometriosis (7.0% vs. 2.3%). Moreover, SUP was associated with an increased risk of primary infertility (adjusted prevalence ratio [PR] 1.83, 95% confidence interval [CI] 1.46-2.24), moderate to intense dysmenorrhea (PR 1.43, 95% CI 1.31-1.52), and moderate to intense deep dyspareunia (PR 1.50, 95% CI 1.25-1.75). In conclusion, in this large surgical series, isolated SUP was independently associated to primary infertility and moderate to severe painful symptoms.
本研究的目的是对大量患有浅表性腹膜子宫内膜异位症（SUP）且无其他类型子宫内膜异位症的女性进行特征描述，以检验SUP与妇科症状之间的关联。我们纳入了203例经组织学证实的SUP病例以及1292例在2004年1月至2017年7月期间诊断为无子宫内膜异位症的对照。参与者为年龄在18至42岁之间、因良性妇科疾病接受腹腔镜检查或剖腹手术的非妊娠患者。我们排除了所有卵巢子宫内膜异位囊肿、深部浸润性子宫内膜异位症病例以及既往接受过子宫内膜异位症手术的女性。所有患者均接受了面对面访谈、全面的术前体格检查和经阴道超声检查。术前通过11点数字评分量表评估疼痛严重程度。使用多变量逻辑回归对SUP与妇科症状之间的关联进行潜在混杂因素调整。SUP的存在与较低的体重（59.8 vs. 63.5千克）和体重指数（21.8 vs. 23.3千克/平方米）、较高的吸烟习惯频率（41.6% vs. 32.8%）以及子宫内膜异位症家族史阳性频率（7.0% vs. 2.3%）相关。此外，SUP与原发性不孕风险增加（调整患病率比[PR] 1.83，95%置信区间[CI] 1.46 - 2.24）、中度至重度痛经（PR 1.43，95% CI 1.31 - 1.52）以及中度至重度深部性交疼痛（PR 1.50，95% CI 1.25 - 1.75）相关。总之，在这个大型手术系列中，孤立性SUP与原发性不孕以及中度至重度疼痛症状独立相关。
