Thornton J G, Morley S, Lilleyman J, Onwude J L, Currie I, Crompton A C
Institute of Epidemiology and Health Services Research, University of Leeds, UK.
Eur J Obstet Gynecol Reprod Biol. 1997 Jul;74(1):57-62. doi: 10.1016/s0301-2115(97)00082-1.
To measure the relationship between laparoscopically detected pelvic pathology and pelvic pain or infertility.
Women undergoing diagnostic laparoscopy either for the investigation of pelvic pain, for sterilisation or for the investigation of infertility were studied. The indication for surgery was recorded before laparoscopy. At operation a series of 35-mm slide photographs were taken of the pelvis and later scored by two independent assessors without knowledge of the indication for surgery.
Satisfactory photographs were obtained in 298 women. Minimal endometriosis was not associated with pain (adjusted OR 1.3; 0.5-2.8), although moderate disease was non-significantly so (2.5; 0.4-7.1). Severe disease was significantly more common and never occurred in patients being sterilised (P = 0.02). The odds of pain were not increased in the presence of dilated veins > 9 mm diameter (OR 1.1; 0.4-3.2) or adhesions (OR 0.6; 0.2-4.7). The odds of infertility were non-significantly increased in the presence of minimal and moderate endometriosis (OR 2.0; 0.8-5.3, and OR 4.2; 0.6-25 respectively) and again significantly more common in the presence of advanced disease (P = 0.002). The odds of infertility tended to be lower in the presence of severely dilated veins (OR 0.2; 0.032-1.2). There was no clear effect of adhesions (OR 0.9; 0.1-5.9).
The long established associations between severe endometriosis and pelvic pain, and between endometriosis in general and infertility are confirmed. However there is little or no association between minimal endometriosis, pelvic adhesions or dilated pelvic veins and pain. Previously reported associations may have been an artefact of the surgeon's knowledge of the indication for operation when assessing the pelvis.
测量腹腔镜检查发现的盆腔病变与盆腔疼痛或不孕之间的关系。
对因盆腔疼痛检查、绝育或不孕检查而接受诊断性腹腔镜检查的女性进行研究。手术指征在腹腔镜检查前记录。手术时拍摄一系列骨盆的35毫米幻灯片照片，随后由两名独立评估人员在不知道手术指征的情况下进行评分。
298名女性获得了满意的照片。轻度子宫内膜异位症与疼痛无关（校正比值比1.3；0.5 - 2.8），尽管中度疾病与之关联不显著（2.5；0.4 - 7.1）。重度疾病明显更常见，且从未在绝育患者中出现（P = 0.02）。直径>9毫米的扩张静脉（比值比1.1；0.4 - 3.2）或粘连（比值比0.6；0.2 - 4.7）的存在并未增加疼痛的几率。轻度和中度子宫内膜异位症存在时不孕的几率非显著增加（分别为比值比2.0；0.8 - 5.3和比值比4.2；0.6 - 25），在重度疾病存在时再次明显更常见（P = 0.002）。严重扩张静脉存在时不孕的几率倾向于较低（比值比0.2；0.032 - 1.2）。粘连没有明显影响（比值比0.9；0.1 - 5.9）。
重度子宫内膜异位症与盆腔疼痛之间以及一般子宫内膜异位症与不孕之间长期存在的关联得到证实。然而，轻度子宫内膜异位症、盆腔粘连或扩张的盆腔静脉与疼痛之间几乎没有关联。先前报道的关联可能是外科医生在评估骨盆时对手术指征的了解所造成的假象。
