Department of Obstetrics and Gynaecology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
Ann Acad Med Singap. 2023 Feb;52(2):71-79. doi: 10.47102/annals-acadmedsg.2022334.
To compare epidemiological features and clinical presentations of deep infiltrating endometriosis with endometrioma and adenomyosis, as well as to identify risk factors for the respective histologically confirmed conditions.
Patients undergoing index surgery at the National University Hospital, Singapore for endometriosis or adenomyosis over a 7-year period-from 2015 to 2021-were identified from hospital databases using the Table of Surgical Procedures coding. Social and epidemiological features of cases with histologically confirmed diagnoses of endometrioma only, adenomyosis only, and deep infiltrating endometriosis were compared. Significant variables from univariate analysis were entered into 3 binary multivariate logistic regression models to obtain independent risk factors for: deep infiltrating endometriosis versus endometrioma only, deep infiltrating endometriosis versus adenomyosis only, and adenomyosis only versus endometrioma only.
A total of 258 patients were included with 59 ovarian endometrioma only, 47 adenomyosis only, and 152 deep infiltrating endometrioses. Compared to endometrioma only, deep infiltrating endometriosis was associated with higher rates of severe dysmenorrhoea (odds ratio [OR] 2.80, 95% confidence interval [CI] 1.02-7.70) and out-of-pocket private surgical care (OR 4.72, 95% CI 1.85-12.04). Compared to adenomyosis only, deep infiltrating endometriosis was associated with a higher fertility desire (OR 13.47, 95% CI 1.01-180.59) and a lower body mass index (OR 0.89, 95% CI 0.79-0.99). In contrast, heavy menstrual bleeding was the hallmark of adenomyosis, being less common in patients with endometriosis.
Deep infiltrating endometriosis is associated with severe dysmenorrhoea, pain related to urinary and gastrointestinal tracts, higher fertility desire and infertility rate. Patients with pain symptomatology and subfertility should be referred early to a tertiary centre with the capability to diagnose and manage deep infiltrating endometriosis.
本研究旨在比较深部浸润性子宫内膜异位症（DIE）、卵巢子宫内膜异位囊肿（内异瘤）和子宫腺肌症的流行病学特征和临床表现，并确定各自经组织学证实的疾病的风险因素。
本研究通过手术程序表编码，从新加坡国立大学医院的医院数据库中确定了 2015 年至 2021 年期间因子宫内膜异位症或子宫腺肌症而接受指数手术的患者。比较了组织学诊断为单纯内异瘤、单纯腺肌症和深部浸润性子宫内膜异位症的病例的社会和流行病学特征。对单变量分析中的显著变量进行了 3 项二元多变量逻辑回归模型分析，以获得深部浸润性子宫内膜异位症与单纯内异瘤、深部浸润性子宫内膜异位症与单纯腺肌症以及单纯腺肌症与单纯内异瘤的独立风险因素。
共纳入 258 例患者，其中 59 例为单纯卵巢内异瘤，47 例为单纯腺肌症，152 例为深部浸润性子宫内膜异位症。与单纯内异瘤相比，深部浸润性子宫内膜异位症与更严重的痛经（比值比 [OR] 2.80，95%置信区间 [CI] 1.02-7.70）和自费私人手术治疗（OR 4.72，95% CI 1.85-12.04）的发生率更高。与单纯腺肌症相比，深部浸润性子宫内膜异位症与更高的生育愿望（OR 13.47，95% CI 1.01-180.59）和更低的体重指数（OR 0.89，95% CI 0.79-0.99）相关。相比之下，月经过多是子宫腺肌症的特征，在子宫内膜异位症患者中较少见。
深部浸润性子宫内膜异位症与严重痛经、与泌尿道和胃肠道相关的疼痛、更高的生育愿望和不孕率相关。有疼痛症状和生育力低下的患者应尽早转介到具有诊断和治疗深部浸润性子宫内膜异位症能力的三级中心。
