经腹腔镜治疗卵巢子宫内膜异位症24例体会

随着腹腔镜技术的迅速发展，使得子宫内膜异位症的早期诊断及治疗成为可能。我院自1999年1月至2006年12月经腹腔镜治疗卵巢子宫内膜异位症24例，现报道如下。     

青春期子宫内膜异位症的研究进展

近年来,青春期子宫内膜异位症发病率有逐年上升的趋势,是妇科一个棘手的问题。年轻患者首发症状为腹痛,甚至是发生于月经来潮前。该病的诊断通常是延迟的,甚至导致输卵管卵巢结构严重受损。原因是多方面的,最主要的是诊断延迟。目前认为,腹腔镜下组织活检是诊断青春期子宫内膜异位症的金标准,经阴道超声和经阴道注水腹腔镜也可协助诊断。腹腔镜诊断及治疗加以术后辅助药物可减少疾病的复发,治疗时间应持续至完成生育。     

子宫内膜异位症和子宫腺肌病与复发性流产

子宫内膜异位症和子宫腺肌病是妇科常见疾病。越来越多的证据表明,这两种疾病对生殖功能有重要影响。临床可表现为不孕不育和流产等,尤其是早期流产。子宫内膜异位症引起流产的原因主要有疾病导致的内分泌功能异常、子宫内膜容受性降低和免疫因素等。子宫腺肌病导致流产的机制主要是子宫螺旋动脉重塑受损和子宫结合带结构功能异常。临床应注重自然流产患者子宫内膜异位症和子宫腺肌病的有关筛查与诊断,并在下次妊娠前给予积极的治疗。     

子宫内膜异位症与白细胞介素16关系的研究进展

子宫内膜异位症是一种女性常见妇科疾病,组织学特征是子宫内膜组织移位到子宫外,包括盆腔腹膜、卵巢和肠等。痛经、慢性盆腔痛、月经异常和不孕是其主要症状,导致的个体和全球社会经济负担十分显著。腹腔镜检查仍然是诊断病情的金标准。然而,手术的侵入性,加上缺乏实验室生物标志物,导致从症状发作到明确诊断的平均潜伏期为7～11年。而且,诊断的延迟可能会对疾病进展产生重大影响。对子宫内膜异位症的非手术检测,发现敏感度和特异度均较高的生物标志物有助于早期诊断和预防有害后遗症,并且是一个明确的研究重点。目前子宫内膜异位症发病机制不明,免疫因素及炎症反应被报道在发病中起着重要作用。其中,白细胞介素16（IL-16）在子宫内膜异位症发病机制中的作用日益受到重视。IL-16是一种趋化因子和T细胞激活的调节剂,由CD4介导其信号转导过程。综述IL-16的表达与子宫内膜异位症发病的关系。     

子宫内膜异位症与白细胞介素16关系的研究进展

子宫内膜异位症是一种女性常见妇科疾病,组织学特征是子宫内膜组织移位到子宫外,包括盆腔腹膜、卵巢和肠等。痛经、慢性盆腔痛、月经异常和不孕是其主要症状,导致的个体和全球社会经济负担十分显著。腹腔镜检查仍然是诊断病情的金标准。然而,手术的侵入性,加上缺乏实验室生物标志物,导致从症状发作到明确诊断的平均潜伏期为7～11年。而且,诊断的延迟可能会对疾病进展产生重大影响。对子宫内膜异位症的非手术检测,发现敏感度和特异度均较高的生物标志物有助于早期诊断和预防有害后遗症,并且是一个明确的研究重点。目前子宫内膜异位症发病机制不明,免疫因素及炎症反应被报道在发病中起着重要作用。其中,白细胞介素16(IL-16)在子宫内膜异位症发病机制中的作用日益受到重视。IL-16是一种趋化因子和T细胞激活的调节剂,由CD4介导其信号转导过程。综述IL-16的表达与子宫内膜异位症发病的关系。     

子宫内膜异位症和子宫腺肌病与复发性流产

子宫内膜异位症和子宫腺肌病是妇科常见疾病。越来越多的证据表明，这两种疾病对生殖功能有重要影响。临床可表现为不孕不育和流产等，尤其是早期流产。子宫内膜异位症引起流产的原因主要有疾病导致的内分泌功能异常、子宫内膜容受性降低和免疫因素等。子宫腺肌病导致流产的机制主要是子宫螺旋动脉重塑受损和子宫结合带结构功能异常。临床应注重自然流产患者子宫内膜异位症和子宫腺肌病的有关筛查与诊断，并在下次妊娠前给予积极的治疗。     

子宫内膜异位症和子宫腺肌病的诊断与分型

子宫内膜异位症和子宫腺肌病是子宫内膜生长在子宫腔以外形成病灶、引起症状和体征的一类疾病。痛经、不孕、性交痛、盆腔包块、子宫直肠窝触痛结节是其主要表现。超声和MRI对子宫内膜异位症和子宫腺肌病的诊断非常有帮助,腹腔镜应作为主要手术治疗手段。到目前为止,还没有对子宫内膜异位症提出统一的分类标准。     

自身抗体与子宫内膜异位症关系的研究进展

子宫内膜异位症（endometriosis,EMs）是育龄期妇女常见的良性疾病,但具有侵袭、种植及复发等恶性倾向,主要表现为痛经、月经紊乱、性交痛等,与不孕关系密切,其发病机制尚不明确。近年来多数研究认为,子宫内膜异位症是一种自身免疫性疾病,自身免疫反应在其发病机制中可能起一定作用。检测自身抗体可能为子宫内膜异位症的早期诊断提供新的辅助指标。     

子宫内膜异位症诊疗现状

子宫内膜异位症(内异症)是生育期妇女常见多发病之一,虽非恶性肿瘤,但却是一种持续性活跃的疾病,在绝经前尚无理想的治疗方法,直接影响了广大妇女的生活质量。1980年在美国成立世界子宫内膜异位症协会(World Endometriosis Soci—ety),并先后召开了7次世界子宫内膜异位症会议,交流讨论关于子宫内膜异位症的发病机理、诊断、     

185例卵巢子宫内膜异位症的临床分析

目的：探究卵巢子宫内膜异位症的临床特征,分析总结诊断卵巢子宫内膜异位症的诊断和治疗经验。方法：选取我院2010年6月至2013年6月期间收治的185例卵巢子宫内膜异位症患者的临床资料,回顾性分析所有病例的发病年龄、既往病史、临床症状等。应用科学的统计方法分析结果。结果：卵巢子宫内膜异位症多发于育龄期;有临床症状的患者有123例（66.5%）,常见痛经、月经不调、小腹无规律疼痛甚至不孕等临床症状;中后期卵巢子宫内膜异位症的患者血清CA125值明显高于早期患者。结论：一旦确诊为卵巢子宫内膜异位症,要尽快进行治疗,保证生活质量。     

Relationship between delay of surgical diagnosis and severity of disease in patients with symptomatic deep infiltrating endometriosis

We investigated relationships between delay of surgical diagnosis and severity of disease in 95 patients with symptomatic deep infiltrating endometriosis. The delay before surgical diagnosis of deep infiltrating endometriosis was significantly longer for patients with advanced stage IV (revised American Society for Reproductive Medicine [ASRM] score >70) disease than for those with stage I, II, III, or IV (revised ASRM score 相似文献   

Non-invasive methods of diagnosis of endometriosis

PURPOSE OF REVIEW: Laparoscopy is the gold standard for the diagnosis of endometriosis but the need for visual evidence of the disease is a major stumbling-block for both effective clinical management of affected patients as well as for research into this common and debilitating reproductive disease. Laparoscopy is invasive and often causes a delay in diagnosis and treatment, especially in symptomatic teenagers and young women. Moreover, the visual inspection of the pelvis has major limitations, particularly for the diagnosis of retroperitoneal lesions. It is therefore not surprising that considerable efforts are being made to improve imaging techniques and to evaluate the diagnostic value of potential molecular markers of disease. RECENT FINDINGS: High-resolution transvaginal ultrasonography and, in selected cases, magnetic resonance imaging improve the diagnosis of retroperitoneal pelvic endometriosis as well as the identification of lesions that involve pelvic organs. A variety of serum and endometrial markers are being evaluated for their diagnostic potential, particularly in endometriosis associated infertility. The first gene profiling studies are showing positive results and proteomic technology is being applied to identify novel diagnostic protein expression patterns. SUMMARY: Current imaging techniques, such as transvaginal ultrasonography, are useful to screen the pelvis for the presence of retroperitoneal endometriosis but fail to diagnose peritoneal lesions, small ovarian endometriomas and adhesions. Postgenomic technologies and identification of novel serum and endometrial markers are likely to revolutionize future diagnosis of endometriosis.     

Impact of endometriosis on women's health: comparative historical data show that the earlier the onset, the more severe the disease

Looking at endometriosis from the bigger picture -- as a systemic endocrine, immunological, and gastrointestinal disease -- opens the door to broader treatments. The bigger-picture understanding of the disease also makes clear a variety of patterns of presenting symptoms, again clarifying the diagnosis. Data from over 7000 confirmed cases clearly show that delay in diagnosis (the average time to diagnosis is >9 years) is a major problem and that current treatments are far from satisfactory. In conclusion, the impact of endometriosis, a disease that already produces intense symptoms, is worsened by a current lack of understanding of the disease beyond its pelvic definition.     

Diagnostic delay in women with pain and endometriosis

BACKGROUND: Women with endometriosis claim that delayed diagnosis is a problem. Anglo-American studies have shown a delay from 3 to 11 years between the onset of pain symptoms and the final diagnosis of endometriosis. The aim of this study was to find the time difference between the onset of pelvic pain symptoms and the final diagnosis of endometriosis among Norwegian patients. MATERIAL AND METHODS: Questionnaires were sent to 400 women, of whom 313 were members of the Norwegian Endometriosis Association and 87 were patients with endometriosis being hospitalized at St Olav's Hospital, Trondheim, in recent years. The response rate was 89%. Among the 356 questionnaires returned, 95 were excluded as not fulfilling the inclusion criterion of surgically verified symptomatic endometriosis or incomplete questionnaires. Data were analyzed from 261 women, of whom 223 were members of the Norwegian Endometriosis Association. In all included patients, pain was an indication for diagnostic surgery. RESULTS: The mean delay in diagnosis was 6.7 +/- 6.2 years and the median delay was 5.0 years for the two groups in total. There was no statistically significant difference in delay between the two recruitment groups. Mean delay in diagnosis had not changed significantly with time. Women reporting infertility in addition to pain did not have a significantly shorter delay. CONCLUSION: In Norway there is a considerable delay in the diagnosis of endometriosis, with figures comparable to results from Anglo-American studies. A greater awareness of symptoms of endometriosis and a more rapid investigation should thus be encouraged.     

盆腔外子宫内膜异位症的诊治进展

子宫内膜异位症（endometriosis，EMs）是育龄期妇女常见的良性疾病之一，发病率正逐年上升。EMs是指子宫内膜组织出现在正常子宫内膜以外的部位，大多累及盆腔脏器和壁腹膜，如卵巢、骶韧带等。EMs的发病机制尚未完全明确，目前普遍接受的理论有经血逆流假说、体腔上皮化生假说、医源性种植、淋巴转移和血行播散假说等。诊断可依靠临床表现、影像学检查和病理学结果。治疗方式主要有药物治疗和手术治疗。盆腔外子宫内膜异位症（extra-pelvic endometriosis）是一种少见的EMs，发生在盆腔以外的部位，如腹壁、胸腔及会阴等。由于其发病较少，临床症状不典型，因此往往诊断较为困难，常会误诊。为提高盆腔外EMs的诊疗水平，要力求做到早期发现、及时诊断和规范化治疗，以改善患者预后。     

Scar endometriosis—a diagnostic dilemma

To diagnose scar endometriosis when an abdominal wall mass is found near the scar from a previous operation requires a high degree of suspicion. Pre-operatively, ultrasound and fine needle aspiration can be of help. Awareness of diagnosis avoids delay in diagnosis, treatment, and unnecessary referrals to other specialities. We reviewed five cases of scar endometriosis presenting to our unit in the last 5 years and included a literature review.     

Endometriosis: Part I. Basic concept

Endometriosis, manifested by pain and infertility, is a chronic inflammatory disease, associated with a large disability of daily living, causing a socio-economic diastrophic problem and burden. The main goal of therapy attempts to reduce pain, correct infertility and possibly avoid or delay occurrence of long-term endometriosis-associated sequelae, such as fibrosis, adhesion and malignant transformation. Although the advanced technology (minimally invasive diagnostic tools, magnetic resonance imaging, high-resolution vaginal ultrasound etc.) and the better understanding pathophysiology of endometriosis for development of new therapeutic strategy is continuous for both diagnosis and management of endometriosis, there is still presence of many debated issues, which commonly occur in routine clinical practice. For example, the timing and duration of medications may be one of most frequently discussed issues. In this part I, we would like to overview the general background knowledge (basic concept) about the endometriosis, and emphasize the role of clinical diagnosis and possible empirical medical treatment (therapeutic test) for the management of women with endometriosis.     

Follow-up report on a randomized controlled trial of laser laparoscopy in the treatment of pelvic pain associated with minimal to moderate endometriosis

Objective: To assess the longer term efficacy of laparoscopic laser surgery in the treatment of painful pelvic endometriosis and to observe the natural history of the disease at second-look laparoscopy in a control group.

Design: One-year follow-up of a prospective, randomized, double-blind controlled trial.

Setting: A referral center for the laparoscopic laser treatment of endometriosis.

Patient(s): Sixty-three patients with pelvic pain and minimal to moderate endometriosis.

Intervention(s): After the 6-month follow-up visit, the randomization code was broken, and follow-up was continued to 1 year. Symptomatic patients were offered second-look laser laparoscopy.

Main Outcome Measure(s): Continued symptom relief at 1 year after treatment and findings at second-look laparoscopy in symptomatic controls.

Result(s): Symptom relief continued at 1 year in 90% of those who initially responded. All symptomatic controls had a second-look procedure, with 7 (29%) showing disease progression, 7 (29%) showing disease regression, and 10 (42%) having static disease.

Conclusion(s): The benefits of laser laparoscopy for painful pelvic endometriosis are continued in the majority of patients at 1 year. Untreated painful endometriosis will progress or remain static in the majority of patients but will spontaneously improve in others.     

腹腔镜在子宫内膜异位症中的应用现状及局限性

子宫内膜异位症(内异症)是生育年龄妇女的常见病,发病率可高达10%～15%。主要引发疼痛?不孕及盆腔包块三大临床问题。腹腔镜是目前诊断内异症的金标准和首选的治疗手段。但由于内异症本身的病变特点,以及在治疗重度内异症或者深部浸润型子宫内膜异位症(deep infil-trating endometriosis,DIE)方面的困难性和复杂性,腹腔镜在诊治内异症的临床应用过程中仍然存在一定的局限性。