Acute Gynaecology, Early Pregnancy and Advanced Endosurgery Unit, Nepean Hospital, Sydney Medical School Nepean, University of Sydney, Sydney, Australia.
Department of Obstetrics and Gynecology, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil.
Ultrasound Obstet Gynecol. 2020 Dec;56(6):928-933. doi: 10.1002/uog.22023. Epub 2020 Oct 31.
Pouch of Douglas (POD) obliteration can be predicted with a high degree of certainty and reproducibility using the dynamic transvaginal ultrasound (TVS) sliding-sign technique. So far, studies on POD obliteration prediction have focused on tertiary-care populations with high prevalence of endometriosis; however, POD obliteration may exist in individuals with asymptomatic endometriosis or other conditions. Our primary aim was to determine the prevalence of a negative sliding sign, representing POD obliteration, in a cohort of patients undergoing TVS for any gynecological indication.
This was a prospective observational study of consecutive women with an indication for gynecological TVS, conducted at a high-volume ultrasound practice between July and August 2018. Clinical and surgical history, indication for TVS and TVS findings were documented. The prevalence of TVS-confirmed POD obliteration, determined by interpretation of the sliding sign, was calculated for the entire cohort and for the subgroups of women with and without risk factors for endometriosis. High risk for endometriosis was defined as having (1) a TVS referral for endometriosis-like pelvic pain or endometriosis specifically and/or (2) clinical symptoms or signs suggestive of endometriosis. Low risk was defined as the absence of these characteristics.
During the study period, 1043 consecutive women underwent TVS. After excluding those who underwent transabdominal ultrasound, had a history of hysterectomy or with missing data, 909 women were analyzed. The prevalence of a negative sliding sign in the entire cohort was 47/909 (5.2%). A negative sliding sign was observed in 22/639 (3.4%) women with a low risk for endometriosis and 25/243 (10.3%) of those with a high risk for endometriosis (difference in proportions, 6.9% (95% CI 2.8-10.9%); P < 0.001).
We have demonstrated an overall prevalence of a negative sliding sign, suggesting POD obliteration, of 5.2% (or 1/20) in women seeking TVS for a gynecological indication. The prevalence of negative sliding sign in low-risk women is not negligible (3.4% or 1/29 women). These women are most likely to have asymptomatic endometriosis or another important etiology of POD obliteration. The prevalence of a negative sliding sign is approximately three-times higher in women with signs and/or symptoms of endometriosis (10.3% vs 3.4%). Copyright © 2020 ISUOG. Published by John Wiley & Sons Ltd.
使用经阴道超声（TVS）滑动信号技术，可以高度确定和重现 pouch of Douglas（POD）消失。到目前为止，POD 消失的预测研究主要集中在高发子宫内膜异位症的三级保健人群中；然而，POD 消失可能存在于无症状子宫内膜异位症或其他疾病的个体中。我们的主要目的是确定在因任何妇科原因接受 TVS 的患者队列中，具有阴性滑动征（代表 POD 消失）的比例。
这是一项在 2018 年 7 月至 8 月期间在一家大容量超声诊所进行的连续接受 TVS 的女性的前瞻性观察性研究。记录了临床和手术史、TVS 指征和 TVS 结果。通过解释滑动信号，计算了整个队列以及具有和不具有子宫内膜异位症危险因素的女性亚组中经 TVS 确认的 POD 消失的发生率。子宫内膜异位症的高风险定义为具有（1）TVS 转诊为子宫内膜异位症样盆腔痛或专门针对子宫内膜异位症，或（2）有子宫内膜异位症的临床症状或体征。低风险定义为没有这些特征。
在研究期间，对 1043 例连续女性进行了 TVS。排除经腹超声、子宫切除术或数据缺失的患者后，对 909 例女性进行了分析。整个队列中阴性滑动信号的发生率为 47/909（5.2%）。在低风险的 639 名女性中有 22 名（3.4%）和高风险的 243 名女性中有 25 名（10.3%）观察到阴性滑动信号（比例差异，6.9%（95%CI 2.8-10.9%）；P<0.001）。
我们已经证明，在因妇科原因接受 TVS 的女性中，阴性滑动信号（提示 POD 消失）的总体发生率为 5.2%（或 20 例中的 1 例）。低风险女性的阴性滑动信号发生率并不低（3.4%，即 29 名女性中有 1 名）。这些女性很可能患有无症状子宫内膜异位症或 POD 消失的另一个重要病因。有子宫内膜异位症症状和/或体征的女性的阴性滑动信号发生率大约高 3 倍（10.3%比 3.4%）。版权所有 © 2020 ISUOG。由 John Wiley & Sons Ltd 出版。
