Department of Obstetrics and Gynecology, University of British Columbia, F2 - 4500 Oak Street, Vancouver, British Columbia, V6H 3N1, Canada.
Department of Obstetrics and Gynecology, University of British Columbia, 275 - 2660 Oak Street, Vancouver, British Columbia, V6H 3Z6, Canada.
Best Pract Res Clin Obstet Gynaecol. 2021 Mar;71:2-13. doi: 10.1016/j.bpobgyn.2020.05.009. Epub 2020 Jun 6.
The pathogenesis of bowel endometriosis is multifactorial. There is a predilection for disease of the rectum/sigmoid colon because refluxed endometrium is more likely to settle in the pouch of Douglas and its movement is delimited by the sigmoid colon, in addition to the close proximity of the rectum/sigmoid to posterior extrinsic uterine adenomyosis and to ovarian endometriomas. Once situated, deep bowel endometriosis has features of invasion, angiogenesis, and fibrosis (repeated tissue injury and repair), with emerging research on oxidative stress and the microbiome. Furthermore, deep bowel endometriosis is associated with neurogenesis and/or the recruitment of local nerve fibers and is capable of invading existing nerves, which in turn may also promote fibrosis. Recently, somatic cancer driver mutations (e.g., in KRAS) were identified in deep bowel endometriosis, which may play a role in the genetic/epigenetic theory of endometriosis. In the future, it is possible that bowel endometriosis could be classified based on molecular features.
肠子宫内膜异位症的发病机制是多因素的。直肠/乙状结肠更容易患病，因为反流的子宫内膜更容易在道格拉斯窝中沉积，并且其运动受到乙状结肠的限制，此外，直肠/乙状结肠靠近子宫后外部腺肌病和卵巢子宫内膜异位囊肿。一旦定位，深部肠子宫内膜异位症具有侵袭、血管生成和纤维化（反复的组织损伤和修复）的特征，目前正在研究氧化应激和微生物组。此外，深部肠子宫内膜异位症与神经发生和/或局部神经纤维的募集有关，并且能够侵袭现有神经，这反过来也可能促进纤维化。最近，在深部肠子宫内膜异位症中发现了体细胞癌症驱动突变（例如 KRAS 中的突变），这可能在子宫内膜异位症的遗传/表观遗传理论中发挥作用。未来，肠子宫内膜异位症可能会根据分子特征进行分类。
