Agossou Moustapha, Sanchez Bruno-Gilbert, Alauzen Paul-Henri, Olivier Maud, Cécilia-Joseph Elsa, Chevallier Ludivine, Jean-Laurent Mehdi, Aline-Fardin Aude, Dramé Moustapha, Venissac Nicolas
Department of Respiratory Medicine, CHU of Martinique, 97261 Fort-de-France, France.
Department of Thoracic and Cardiovascular Surgery, CHU of Martinique, 97261 Fort-de-France, France.
J Clin Med. 2023 Aug 26;12(17):5578. doi: 10.3390/jcm12175578.
Endometriosis is a female disease that affects 5-10% of women of childbearing age, with predominantly pelvic manifestations. It is currently declared as a public health priority in France. Thoracic endometriosis syndrome (TES) is the most common extra-pelvic manifestation.
The objective of this study was to describe the epidemiological and clinical characteristics, and outcomes of patients with TES in Martinique.
We performed a descriptive, retrospective study including all patients managed at the University Hospital of Martinique for TES between 1 January 2004 and 31 December 2020.
During the study period, we identified 479 cases of pneumothorax, of which 212 were women (44%). Sixty-three patients (30% of all female pneumothorax) were catamenial pneumothorax (CP) including 49 pneumothoraxes alone (78% of catamenial pneumothorax) and 14 hemopneumothorax (22% of catamenial pneumothorax). There were 71 cases of TES, including 49 pneumothoraxes (69%), 14 hemopneumothoraxes (20%) and 8 hemothorax (11%). The annual incidence of TES was 1.1 cases/100,000 inhabitants. The prevalence of TES was 1.2/1000 women aged from 15 to 45 years and the annual incidence of TES for this group was 6.9/100,000. The annual incidence of CP was 1 case/100,000 inhabitants. The average age at diagnosis was 36 ± 6 years. Eight patients (11%) had no prior diagnosis of pelvic endometriosis (PE). The mean age at pelvic endometriosis diagnosis was 29 ± 6 years. The mean time from symptom onset to diagnosis was 24 ± 50 weeks, and 53 ± 123 days from diagnosis to surgery. Thirty-two patients (47%) had prior abdominopelvic surgery. Seventeen patients (24%) presented other extra-pelvic localizations. When it came to management, 69/71 patients (97%) underwent surgery. Diaphragmatic nodules or perforations were found in 68/69 patients (98.5%). Histological confirmation was obtained in 55/65 patients who underwent resection (84.6%). Forty-four patients (62%) experienced recurrence. The mean time from the initial treatment to recurrence was 20 ± 33 months. The recurrence rate was 16/19 (84.2%) in patients who received medical therapy only, 11/17 (64.7%) in patients treated by surgery alone, and 17/31 (51.8%) in patients treated with surgery and medical therapy ( = 0.03).
We observed a very high incidence of TES in Martinique. The factors associated with this high incidence in this specific geographical area remain to be elucidated. The frequency of recurrence was lower in patients who received both hormone therapy and surgery.
子宫内膜异位症是一种女性疾病，影响5%-10%的育龄妇女，主要表现为盆腔症状。目前，它在法国被列为公共卫生重点关注疾病。胸腔子宫内膜异位症综合征（TES）是最常见的盆腔外表现。
本研究旨在描述马提尼克岛TES患者的流行病学和临床特征以及治疗结果。
我们进行了一项描述性回顾性研究，纳入了2004年1月1日至2020年12月31日期间在马提尼克大学医院接受治疗的所有TES患者。
在研究期间，我们共识别出479例气胸病例，其中212例为女性（占44%）。63例患者（占所有女性气胸病例的30%）为月经期气胸（CP），其中仅气胸49例（占月经期气胸的78%），血气胸14例（占月经期气胸的22%）。共有71例TES病例，其中气胸49例（占69%），血气胸14例（占20%），血胸8例（占11%）。TES的年发病率为1.1例/10万居民。TES在15至45岁女性中的患病率为1.2/1000，该组的年发病率为6.9/10万。CP的年发病率为1例/10万居民。诊断时的平均年龄为36±6岁。8例患者（占11%）此前未被诊断出盆腔子宫内膜异位症（PE）。盆腔子宫内膜异位症诊断时的平均年龄为29±6岁。从症状出现到诊断的平均时间为24±50周，从诊断到手术的平均时间为53±123天。32例患者（占47%）曾接受过腹部盆腔手术。17例患者（占24%）有其他盆腔外病变部位。在治疗方面，71例患者中有69例（占97%）接受了手术。69例接受手术的患者中有68例（占98.5%）发现了膈肌结节或穿孔。65例接受切除术的患者中有55例（占84.6%）获得了组织学确诊。44例患者（占62%）出现复发。从初始治疗到复发的平均时间为20±33个月。仅接受药物治疗的患者复发率为16/19（占84.2%），仅接受手术治疗的患者复发率为11/17（占64.7%），接受手术和药物联合治疗的患者复发率为17/31（占51.8%）（P=0.03）。
我们观察到马提尼克岛TES的发病率非常高。在这个特定地理区域，导致这种高发病率的相关因素仍有待阐明。接受激素治疗和手术联合治疗的患者复发频率较低。
