Division of Advanced Gynecology and Pelvic Pain, Department of Obstetrics and Gynecology, St. Joseph's Hospital and Medical Center, Phoenix, AZ, USA.
Phoenix Integrated Residency in Obstetrics and Gynecology, Phoenix, AZ, USA.
Int J Gynaecol Obstet. 2020 Nov;151(2):260-266. doi: 10.1002/ijgo.13303. Epub 2020 Aug 2.
To determine the prevalence of occult microscopic endometriosis in patients with chronic pelvic pain and negative laparoscopy.
A retrospective cross-sectional study included women who underwent laparoscopic evaluation for chronic pelvic pain by three fellowship-trained gynecologic surgeons at a community hospital from January 2011 to December 2016. The aim was to evaluate the prevalence of microscopic endometriosis in this population.
In 142 patients with clinically negative peritoneum on laparoscopy, 39% had occult microscopic endometriosis. Cramping pain score during menses was found to be lower in the positive biopsy group (6.9 vs 8.0, P=0.046). No differences were appreciated in age of menarche, pain during various parts of the menstrual cycle, or duration of symptoms. The biopsy-positive group had a younger age at time of evaluation, although not statistically significant (P=0.179). Current use of hormones affected neither biopsy results nor menstrual or pain characteristics. Detection was similar between robotic and laparoscopic cases and operative morbidity was minimal.
Occult microscopic endometriosis may be present in approximately 39% of patients with clinically negative appearing peritoneum undergoing laparoscopy for chronic pelvic pain. Given this, biopsies should be performed in patients undergoing laparoscopy who do not have visible lesions.
确定慢性盆腔痛且腹腔镜检查阴性患者中隐匿性显微镜下子宫内膜异位症的患病率。
本回顾性横断面研究纳入了 2011 年 1 月至 2016 年 12 月期间在一家社区医院由三位妇科专业培训医师进行腹腔镜评估的慢性盆腔痛女性患者。目的是评估该人群中显微镜下子宫内膜异位症的患病率。
在 142 例腹腔镜检查时腹膜临床阴性的患者中，有 39%存在隐匿性显微镜下子宫内膜异位症。活检阳性组的经期痉挛性疼痛评分较低（6.9 分 vs 8.0 分，P=0.046）。在初潮年龄、各月经周期期间的疼痛或症状持续时间方面，两组间无差异。尽管无统计学意义（P=0.179），但活检阳性组在评估时年龄更轻。目前激素的使用既不影响活检结果，也不影响月经或疼痛特征。机器人辅助腹腔镜和腹腔镜检查的检出率相似，手术发病率很低。
在接受腹腔镜检查的慢性盆腔痛且腹膜临床外观正常的患者中，约有 39%可能存在隐匿性显微镜下子宫内膜异位症。鉴于此，对于腹腔镜检查时未见明显病变的患者，应进行活检。
