Balasch J, Creus M, Fábregues F, Carmona F, Ordi J, Martinez-Román S, Vanrell J A
Department of Obstetrics and Gynaecology, Faculty of Medicine, University of Barcelona, Hospital Clínic i Provincial, Spain.
Hum Reprod. 1996 Feb;11(2):387-91. doi: 10.1093/humrep/11.2.387.
In 100 consecutive patients who were undergoing laparoscopy for infertility (group 1, n = 52), chronic pelvic pain (group 2, n = 18) or tubal sterilization (group 3, n = 30, asymptomatic fertile women), peritoneal biopsies were taken from areas of visually normal peritoneum of uterosacral ligaments. Twenty-six patients in group 1 (50%), eight patients in group 2 (44.4%) and 13 patients in group 3 (43.3%), were found to have laparoscopic evidence of endometriosis elsewhere in the pelvis. The majority of women (80.7% in group 1, 87.5% in group 2, and 100% in group 3) had stage I disease. The incidence of the distinctive appearances of the lesions was similar in the three groups of patients and 7% of all women or 15% (7/47) of those patients having endometriosis at laparoscopy had only subtle (non-¿typical') endometriotic peritoneal lesions. Uterosacral biopsies showed the presence of endometriotic tissue in three cases (5.7%), two cases (11%) and three cases (10%) in groups 1, 2, and 3 respectively. One of the two patients in group 2 and two of the three patients in group 3 had no evidence of endometriosis at laparoscopy; thus histological study revealed the presence of endometriosis in normal peritoneum in 11% (5/47) of patients having macroscopic endometriosis and in 6% (3/53) of patients without endometriosis at laparoscopy. Previous oral contraceptive users were significantly higher among women having macroscopic and/or microscopic endometriosis than among women without the condition. In conclusion, our prospective study shows a high prevalence (45-50%) of endometriosis (including microscopic forms) in both patients with chronic pelvic pain and asymptomatic women (fertile and infertile), thus supporting the modern concept that in many women endometriosis may be a paraphysiological condition while probably only in some patients small amounts of endometriosis are an ¿annoyance' with implications to their reproductive health and may produce symptoms (e.g. pelvic pain) and therefore should be defined as a ¿dis-ease'. Previous use of oral contraceptives may increase the risk of developing endometriosis.
在100例连续接受腹腔镜检查的患者中，因不孕症接受检查的患者为第1组（n = 52），因慢性盆腔疼痛接受检查的患者为第2组（n = 18），因输卵管绝育接受检查的患者为第3组（n = 30，无症状的可育女性），从子宫骶韧带外观正常的腹膜区域取腹膜活检样本。第1组中有26例患者（50%）、第2组中有8例患者（44.4%）、第3组中有13例患者（43.3%）被发现盆腔其他部位有腹腔镜检查证实的子宫内膜异位症。大多数女性（第1组为80.7%，第2组为87.5%，第3组为100%）为I期疾病。三组患者中病变的独特外观发生率相似，所有女性中有7%或腹腔镜检查发现有子宫内膜异位症的患者中有15%（7/47）仅有细微（“非典型”）的子宫内膜异位症腹膜病变。子宫骶韧带活检显示，第1组、第2组和第3组分别有3例（5.7%）、2例（11%）和3例（10%）存在子宫内膜异位组织。第2组的2例患者中有1例、第3组的3例患者中有2例在腹腔镜检查时没有子宫内膜异位症的证据；因此，组织学研究显示，在腹腔镜检查时有肉眼可见子宫内膜异位症的患者中，11%（5/47）的正常腹膜存在子宫内膜异位症，在腹腔镜检查时无子宫内膜异位症的患者中，6%（3/53）的正常腹膜存在子宫内膜异位症。有肉眼可见和/或显微镜下子宫内膜异位症的女性中，既往口服避孕药使用者的比例显著高于无此病的女性。总之，我们的前瞻性研究表明，慢性盆腔疼痛患者和无症状女性（可育和不育）中子宫内膜异位症（包括显微镜下形式）的患病率都很高（45 - 50%），这支持了现代观念，即对许多女性来说，子宫内膜异位症可能是一种旁生理状态，而可能只有一些患者少量的子宫内膜异位症是一种对其生殖健康有影响的“麻烦”，并可能产生症状（如盆腔疼痛），因此应被定义为一种“疾病”。既往使用口服避孕药可能会增加患子宫内膜异位症的风险。
