Jenkins S, Olive D L, Haney A F
Obstet Gynecol. 1986 Mar;67(3):335-8.
The authors have reassessed the anatomic distribution of ectopic endometrium by the laparoscopic study of the location of implants, adhesions, and uterine position in 182 consecutive patients with infertility and endometriosis. The ovary was the most common site of implants with 54.9% having either unilateral or bilateral involvement. This was followed, in order of frequency, by the posterior broad ligament (35.2%), the anterior cul-de-sac (34.6%), the posterior cul-de-sac (34.0%), and the uterosacral ligament (28.0%). Adhesion formation followed the same anatomic distribution. No patients were noted to have endometriosis of the cervix and vagina. Endometriosis of the anterior compartment (anterior cul-de-sac, anterior broad ligament, and anterior uterine serosa) was significantly more common in patients with anterior uteri (40.7%) versus patients with posterior uteri (11.8%, P less than .0005). Exclusive anterior compartment disease was found only in patients with anterior uteri, and significantly more commonly in patients with severely anteflexed uteri (P less than .005). These data suggest that factors influencing implantation of retrograde menstrual debris include: the dependent pooling of peritoneal fluid as affected by uterine position; epithelial cell type at the site of implantation; unique ovarian susceptibility; route of entry; and mobility of the pelvic structures. The data support the Sampson hypothesis of retrograde menstruation as the primary model of development of endometriosis.
作者通过对182例连续的不孕症和子宫内膜异位症患者进行腹腔镜检查，研究植入物的位置、粘连情况和子宫位置，重新评估了异位子宫内膜的解剖分布。卵巢是最常见的植入部位，54.9%的患者有单侧或双侧受累。其次，按频率依次为阔韧带后叶（35.2%）、前陷凹（34.6%）、后陷凹（34.0%）和子宫骶韧带（28.0%）。粘连形成遵循相同的解剖分布。未发现有宫颈和阴道子宫内膜异位症的患者。前位子宫患者的前侧腔隙（前陷凹、阔韧带前叶和子宫前浆膜）子宫内膜异位症明显比后位子宫患者更常见（分别为40.7%和11.8%，P<0.0005）。仅在前位子宫患者中发现了单纯的前侧腔隙疾病，并且在严重前屈子宫患者中更常见（P<0.005）。这些数据表明，影响逆行月经碎片植入的因素包括：受子宫位置影响的腹膜液依赖性积聚；植入部位的上皮细胞类型；独特的卵巢易感性；进入途径；以及盆腔结构的活动度。这些数据支持了桑普森逆行月经假说作为子宫内膜异位症主要发病模型的观点。
