抗生殖免疫抗体及性激素与子宫内膜异位症发病的关系研究

目的 探讨患者抗生殖免疫抗体及性激素的变化与子宫内膜异位症(endometriosis,EMS)发病的关系.方法 回顾性分析268例EMS患者(其中年龄＞35岁组的EMS患者90例;年龄≤35岁组的EMS患者178例)和200例非子宫内膜异位症患者(其中年龄＞35岁组的非子宫内膜异位症患者72例,为同龄对照组;年龄≤35岁组的非子宫内膜异位症患者128例,为同龄对照组)的临床资料.用化学发光免疫分析法检测两组患者血清卵泡刺激素(follicle-stimulating homone,FSH)、黄体生成素(homone,LH)、睾酮(testosterone,T)、雌二醇(estradiol,E2)孕酮(progesterone,P)和泌乳素(prolactin,PRL)水平;采用酶联免疫法检测抗卵巢抗体(anti-ovarian antibodies,AOAb)、抗心磷脂抗体(anticardiolipin antibody,ACL)、抗子宫内膜抗体(anti-endometrial antibodies,EMAb)水平.结果 年龄＞35岁组和年龄≤35岁组EMS患者的P、PRL水平均高于同龄对照组,差异有统计学意义;年龄＞35岁组的EMS患者LH水平也显著高于同龄对照组,差异也有统计学意义(P＜0.05).其他激素各项指标比较,差异无统计学意义(P＞0.05).年龄＞35岁组和年龄≤35岁组EMS患者的抗生殖免疫抗体AOAb、ACL、EMAb阳性率明显高于同龄对照组,差异有统计学意义(P≤0.05).结论 ENS患者存在抗生殖免疫抗体变化,高孕激素、高泌乳素水平可能与EMS发病有关.     

两种剖宫产腹部切口选择对其腹部切口子宫内膜异位症发生率比较

目的通过观察新式剖宫产术与子宫下段剖宫产术两种剖宫产腹壁切口不同选择对其术后并发症腹部切口子宫内膜异位症发生率情况,探讨减少剖宫产术后腹部切口子宫内膜异位症发生率的有效方法。方法 1998年9月~2008年9月在本院仅行1次剖宫产及选择两种不同腹壁切口、随访3年内诊断患有腹部切口子宫内膜异位症的产妇,对两者发生率进行比较。结果 3 150例采用子宫下段剖宫产术产妇3年内患有腹部切口子宫内膜异位症患者为24例;2 942例采用新式剖宫产术产妇3年内患有腹部切口子宫内膜异位症患者为56例,两者发生率有明显统计学差别（P〈0.01）。结论在减少腹部切口子宫内膜异位症发生率,选择子宫下段剖宫产术（纵切口）为一种有效的方法。     

The Long-Term Footprint of Endometriosis: Population-Based Cohort Analysis Reveals Increased Pain Symptoms and Decreased Pain Tolerance at Age 46 Years

Previous studies have shown increased pain sensitivity in fertile-aged women with endometriosis in response to mechanical stimuli. As yet, population-based studies on the association of endometriosis with pain sensation and pain symptoms in late fertile age are lacking. The main objective of this population-based cohort study was to investigate whether a history of endometriosis is associated with altered pain sensation and musculoskeletal pain symptoms at age 46 years. Our data are derived from the Northern Finland Birth Cohort 1966, which contains postal questionnaire data (72% response rate) as well as clinical data assessing pressure-pain threshold and maximal pain tolerance. The study population consisted of 284 women with endometriosis and 3,390 controls. Our results showed that at age 46 women with a history of endometriosis had a 5.3% lower pressure-pain threshold and 5.1% lower maximal pain tolerance compared with controls. The most significant contributors besides endometriosis were anxiety, depression, and current smoking status. Women with endometriosis also reported an increased number of pain sites (0 pain sites, 9.6 vs 17.9%; 5-8 pain sites, 24.8 vs 19.1%, endometriosis vs controls respectively; P?<?.001), and their pain was more troublesome and intense. The results were adjusted for body mass index, smoking, depressive/anxiety symptoms, education, and use of hormonal contraceptives. These unique data revealed an altered pain sensation and a greater likelihood of reporting musculoskeletal pain at age 46 years among women with a history of endometriosis. The results imply that endometriosis has a long-term footprint on affected women, thus underlying the need for psychological support and medical treatment beyond fertile age.

腹腔镜下保守性手术治疗子宫内膜异位症的评价（附48例临床分析）

目的：对腹腔镜下保守性手术治疗子宫内膜异位症进行评价,方法：对48例腹腔镜下保守性手术治疗子宫内膜异位症的临床资料进行分析。结果：腹腔镜下保守性手术治疗子宫内膜异位症适合于35岁以下,希望保留生育的妇女：直径≤10cm的子宫内膜异位囊肿和不明原因的盆腔痛经反复抗炎治疗无效者,是腹腔镜手术的指征,结论：腹腔镜下保守性手术治疗子宫内膜异位症是一种安全的术式。     

Endometriosis and homœopathy: An audit study of 8 consecutive patients

8 consecutive patients with endometriosis were followed up from 1 to 4 years to assess the efficacy of homœopathic treatment. All had laparoscopic grading of their endometriosis. All improved with treatment.     

Primate model research for endometriosis

Endometriosis is defined as the existence of endometrial tissue outside the uterine cavity, and it includes a chronic, inflammatory reaction associated with female infertility and pelvic pain. Endometriosis occurs in 7 to 10% of women. Although it has been studied for more than 50 years, the pathogenesis and development of endometriosis are still poorly understood. There is no curative therapy for endometriosis, which often recurs after surgical or medical treatment. There is a consensus that the adverse current of menstrual blood plays a crucial role in the development of endometriosis. This places a major limitation on research using rodent models of endometriosis, although these are still widely employed, because rodents do not menstruate and endometriosis does not occur spontaneously in these animals. In fact, menstruation and spontaneous endometriosis only occur in women and some non-human primates, making models that employ non-human primates the best animal models for research into the pathogenesis, pathophysiology, spontaneous onset, and treatment of endometriosis. This review assesses the effectiveness and potential of the non-human primate models of endometriosis. It also describes the current findings and theories on the pathogenesis of endometriosis that have been obtained by research using non-human primates.     

剖宫产腹部切口子宫内膜异位症23例临床分析

目的：探讨剖宫产手术后腹部切口子宫内膜异位症诊断、治疗和预防。方法：对23例剖宫产术后腹部切口子宫内膜异位症的患者进行回顾性的分析和总结。结果：剖宫产术后腹部切口子宫内膜异位症是剖宫产术后远期并发症之一,多发生于剖宫产术后2年左右,表现为手术切口部位出现随月经周期而出现的痛性包块,随病程发展而增大,部分患者CA125可有升高,有较典型的病史和临床表现。结论：手术切除包块是治疗宫产术后腹部切口子宫内膜异位症的有效方法,剖宫产术中应严密预防子宫内膜种植。     

腹腔镜下子宫内膜异位症生育指数在子宫内膜异位症合并不孕中的应用研究

目的 分析腹腔镜下子宫内膜异位症生育指数在子宫内膜异位症（EMT）合并不孕中的应用效果。方 法选取我院2011年1月~2013年6月收治的100例子宫内膜异位症合并不孕症患者,给予患者腹腔镜手术治疗,对患者进行子宫内膜异位症生育指数（EFI）评分,分析患者术后妊娠情况。结果100例患者术后3年内有52例成功妊娠,总妊娠率为52%,术后第1年妊娠率为31%,第2年为16%,第3年为5%。EFI评分≤4分患者14例,3年内3例成功妊娠,妊娠率21.4%;5~8分患者49例,3年内21例成功妊娠,妊娠率42.9%;9~10分患者37例,3年内28例成功妊娠,妊娠率75.7%,EFI评分为9~10分患者妊娠率显著优于其他患者（P＜0.05）。结论腹腔镜下子宫内膜异位症生育指数是评价子宫内膜异位症合并不孕患者生育能力的重要指标,临床可根据EFI评分情况给予患者针对性治疗,提高患者妊娠率。     

ENDOMETRIOMA OF THE LIVER

Hepatic endometriosis is extremely rare. The diagnosis is often missed and treatment is delayed. A 37-year-old woman was referred to the gynaecology department with vague abdominal pains. She had a past history of pelvic endometriosis and hysterectomy with bilateral salpingo-oophorectomy. Further investigations in due course confirmed it to be endometriosis of the liver. She was eventually referred to the hepatobiliary unit, almost three years after her first presentation, where she was operated on with good results.     

Nodular endometriosis: dynamic MR imaging

Purpose In this study we aimed to investigate the value of contrast enhanced dynamic MR imaging (DMI) in the diagnosis of nodular abdominal endometriosis. Subjects and methods Fourteen patients with surgically and pathologically proven endometriosis were examined with DMI. The patients were 22–54 years old (mean age 30.8 years). The dynamic MR studies of these patients were retrospectively reviewed by two radiologists who were aware of the clinical data. Nodular masses showing enhancement were evaluated for size, margins, and signal intensity on T1- and T2-weighted MR sequences. The protocol was tailored to selectively determine the diagnostic utility of signal intensity time course analysis for the behavior of nodular endometriosis and endometrial tissue, in DMI. Contrast-enhanced DMI was performed and the time–intensity curves of the lesions and the uterine endometrial tissue of each patient were compared. Mean enhancement values were calculated. Each DMI was evaluated for signal intensity value. Results In 8 (57%) of 14 patients, we found endometriosis in the abdominal wall. All patients with abdominal wall endometriosis had pelvic surgical operation history. Diameter of nodular endometriosis determined in the abdominus muscle ranged between 3 and 40 mm. Of eight cases, five had only one lesion and three had multiple lesions. Remaining 6 (43%) cases had deep pelvic endometriosis located in the uterosacral ligaments (n = 3), rectosigmoid (n = 2), and rectovaginal septum (n = 1). Diameter of pelvic endometriosis ranged between 9 and 53 mm. Noncontrast mean signal intensity of endometriosis and endometrial tissue were 280 ± 73 and 216 ± 20, respectively. The mean values of both endometriosis and normal endometrial tissue were calculated for each patient examined with five-slice DMI. All of the curves showed significant correlation. The lesion showed significant enhancement in the course of time similar to the endometrial tissue in all patients. Conclusion Our study was inspired from the fact that endometriosis is the ectopic endometrial tissue and we thought that endometrial tissue and endometriomas should have similar vascularity. In this way imaging with MR, getting the time–intensity curves and experiencing the correlation between the endometriosis and endometrial tissue may support the diagnosis in the cases with suspected endometriosis. This first study shows that the ectopic nodular endometriosis can easily be identified with dynamic MRI. It may be used to differentiate nodular endometriosis from the other pathologic conditions of abdominal wall and pelvis.     

Systematic Evaluation of Women With Suspected Endometriosis Using a 5‐Domain Sonographically Based Approach

In recent years, knowledge has evolved regarding the role of transvaginal sonography in the assessment of the pouch of Douglas status and the preoperative prediction of extraovarian endometriosis in specific locations. Despite these advances in transvaginal sonography, the challenge of developing a comprehensive, cost‐effective, and reproducible preoperative classification system for endometriosis remains. Critical to this classification system should be a sonographically based evaluation protocol that is systematic, evidence based, and reproducible with clearly defined end points. To date, no structured evaluation protocol exists for the assessment of the pelvis in women with suspected endometriosis. In this article, we propose a domain‐based evaluation protocol for the assessment of women with suspected endometriosis using transvaginal sonography.     

手术切口子宫内膜异位症9例临床分析

目的探讨手术切口子宫内膜异位症的发病机制、诊断和治疗。方法随机选取我院1998～2004年间住院分娩的600例病人作为研究对象,其中剖宫分娩310例,术中采取切口保护158例,切口未保护152例;阴道分娩290例,均行会阴侧切,140例缝合之前以生理盐水冲洗切口,150例未作切口冲洗。在4组病例中以采取处理措施者作为对照组,对照组产后坚持纯母乳喂养6个月至1年,其余未母乳喂养或喂养时间少于6个月,术后严格随访4～10年。结果600例病人中9例发生手术切口瘢痕子宫内膜异位症,其中腹壁切口瘢痕子宫内膜异位症6例,会阴切口子宫内膜异位症3例;发病时间最长8年,最短6个月,平均54个月。术后坚持纯母乳喂养6个月至1年以上者无发病。9例发病者均为未母乳喂养或喂养时间少于6个月者。发生者均为切口未做特殊处理组,对照组无一例发生。结论子宫内膜异位种植是本症的主要发病机制,彻底手术是唯一确实有效的治疗方法。切口保护措施有利于降低切口子宫内膜异位症发生率,延长母乳喂养时间可使切口子宫内膜异位症发病时间推迟。     

子宫内膜异位症合并卵巢恶性肿瘤的临床特点

  目的  探讨子宫内膜异位症合并卵巢恶性肿瘤的临床特点。  方法  对北京协和医院1997年1月至2009年4月间收治的子宫内膜异位症合并卵巢恶性肿瘤的患者共33例进行回顾性分析, 并总结其临床特点。  结果  33例子宫内膜异位症合并卵巢恶性肿瘤患者的平均年龄为45.3岁; 病理类型以透明细胞癌为主; 诊断时分期多为Ⅰ期(24/33);5例患者同时又合并子宫内膜病变; 子宫内膜异位症病灶位于卵巢者19例, 位于卵巢外者14例; 术后5年生存率为60%, 平均无瘤生存期为41.9个月。  结论  子宫内膜异位症合并卵巢恶性肿瘤患者发病年龄较卵巢癌患者年轻, 病理类型以卵巢上皮性肿瘤为主, 透明细胞癌最为常见, 可同时合并有在位子宫内膜肿瘤。合并子宫内膜异位症可能是卵巢癌预后好的指标。     

Noninvasive biomarkers of endometriosis: myth or reality?

Endometriosis affects 10% of premenopausal women and 35–50% of women with infertility, pelvic pain, or both. At present, endometriosis can only be diagnosed with surgery, where laparoscopy is considered a gold standard. Noninvasive biomarkers are thus urgently needed. In 2010, the peripheral biomarkers of endometriosis were systematically reviewed by May et al. However, with the introduction of ‘-omics’ technologies, we have witnessed immense progress in biomarker discovery, which now calls for an overview of recent studies. This report looks at potential blood and urine biomarkers of endometriosis published in the last 3 years. The current status of noninvasive diagnostic biomarkers of endometriosis is discussed, with the limitations of these studies identified and recommendations for future biomarker discovery provided.     

Primary dysmenorrhea or endometriosis?

Dysmenorrhea is a common complaint of women during their reproductive years. Primary dysmenorrhea and endometriosis are the most common forms of pelvic pain. Through a comprehensive health history and physical examination, a clinical diagnosis can be made to facilitate optimum management of symptoms. The incidence, etiology, symptomatology and treatment modalities for these entities are discussed. Particular attention is devoted to the differentiation between primary dysmenorrhea and endometriosis.     

Screening the Role of Pronociceptive Molecules in a Rodent Model of Endometriosis Pain

Chronic pain is a major symptom in patients with endometriosis, a common gynecologic condition affecting women in their reproductive years. Although many proalgesic substances are produced by endometriosis lesions, experimental evidence supporting their relative roles is still lacking. Furthermore, it is unclear whether these proalgesic agents directly activate nociceptors to induce endometriosis pain. To determine their relative contribution to pain associated with endometriosis, we evaluated the intrathecal administration of oligodeoxynucleotides (ODNs) antisense to messenger RNA for receptors for 3 pronociceptive mediators known to be produced by the ectopic endometrium. Two weeks after the implant of autologous uterine tissue onto the gastrocnemius muscle, local mechanical hyperalgesia was observed in operated rats. Intrathecal antisense ODN targeting messenger RNA for the interleukin 6 receptor–signaling complex subunit glycoprotein 130 and the nerve growth factor tyrosine kinase receptor A, but not their mismatch ODNs, reversibly attenuated mechanical hyperalgesia at the implant site. In contrast, intrathecal antisense ODN targeting the tumor necrosis factor receptor 1, at a dose that markedly inhibited intramuscularly injected tumor necrosis factor alpha, had only a small antihyperalgesic effect in this model. These results indicate the relative contribution of pronociceptive mediators produced by ectopic endometrial tissue to endometriosis pain. The experimental approach presented here provides a novel method to evaluate for the differential contribution of mediators produced by other painful lesions as well as endometriosis lesions as targets for novel treatment of pain syndromes.PerspectiveThis article presents evidence for the relative contribution of proalgesic mediators to primary hyperalgesia displayed by rats submitted to a model of endometriosis pain. This approach can be used to identify potential targets for the treatment of endometriosis pain.     

Deep pelvic endometriosis: don’t forget round ligaments. Review of anatomy,clinical characteristics,and MR imaging features

Deep infiltrating endometriosis is an important gynecologic disease that may develop during the reproductive years and is responsible for severe pelvic pain. Deep pelvic endometriosis can affect the retrocervical region, uterosacral ligament, rectum, rectovaginal septum, vagina, urinary tract, and other extraperitoneal pelvic sites. Surgery remains the best therapeutic treatment for affected patients and an accurate preoperative evaluation of the extension of endometriotic lesions is essential for a successful outcome. However, many atypical locations for deep pelvic endometriosis exist although still lesser known to both gynecologists and radiologists such as endometriosis of the round ligaments of the uterus (RLUs). In this article, we review embryology and anatomy of the RLUs as well clinical characteristics associated with these endometriotic locations. In addition, we describe magnetic resonance (MR) imaging protocol, normal MR imaging appearances of the RLUs and the most common abnormal findings of endometriotic involvement of these ligaments at MR imaging. Radiologists should always keep in mind the RLUs as a possible site of deep pelvic endometriosis localization and should not forget to carefully look for them on MR images.     

Scar endometriosis developing after an umbilical hernia repair with mesh

A 44-year-old female was initially evaluated for a 3-cm umbilical hernia, which developed after a laparoscopic myomectomy performed seven years prior. The umbilical hernia was repaired using a synthetic mesh. Eight months after the umbilical hernia repair, the patient returned with chronic pain in a 3-cm raised mass originating from the umbilical hernia repair incision. The mass and mesh were surgically removed. The umbilical fascial defect was repaired with a primary fascia-to-fascia closure and the umbilicus was reconstructed from adjacent skin. The mass was found histologically to be endometriosis and fascial scarring with a foreign body reaction to synthetic mesh. Umbilical endometriosis developed either from peritoneal endometrial seeding from a laparoscopic myomectomy or from metaplasia of multipotential cells, which developed into endometriosis due to inflammatory stimulation by the synthetic mesh. Synthetic mesh probably should be avoided in the surgical repair of a laparoscopically caused umbilical hernia in a premenopausal female especially if there is a history of pelvic endometriosis.     

腹腔镜联合药物治疗830例子宫内膜异位症的临床分析

目的：分析腹腔镜手术联合药物治疗子宫内膜异位症的疗效。方法：回顾性分析2002年至2005年四川大学华西第二医院收治的830例子宫内膜异位症患者腹腔镜手术治疗后的随访资料。比较手术后加用丹那唑、孕三烯酮（内美通）、诺雷得以及中药治疗3个月后的轻、重度子宫内膜异位症的复发率、合并不孕患者的受孕率。结果：术后两年,各药物组在各类中受孕率及在轻度中复发率无明显差异,在重度中,中药组复发率显著高于其他各药物组。结论：子宫内膜异位症腹腔镜手术后联合用药可降低复发率,提高受孕率。中药组的复发率在重度子宫内膜异位症中要高于其他组。各药物组在受孕率上无显著差异。     

Sexual function in patients with endometriosis: a prospective case–control study in China

ObjectiveEndometriosis is a common disease in women of childbearing age, leading to sexual dysfunction or loss of libido. We aimed to evaluated the effect of endometriosis on women’s sexual function.MethodsWe performed a prospective case–control study to determine the effect of endometriosis on women’s sexual function using a self-administered questionnaire from September 2017 to August 2018. The simplified Chinese version of the Female Sexual Function Index (FSFI) was used to assess sexual function.ResultsWe found that sexual function of women in the endometriosis group (n=77) in all dimensions was significantly lower compared with that in the control group (n=63). The total FSFI score in patients was 25.5, which tended to be lower than that in the control group (26.7). Sexual arousal, sexual pain, and satisfaction were significantly different between the two groups. Sexual arousal and sexual pain scores were significantly lower in the endometriosis group than in the control group at the ages of 31 to 40 years.ConclusionWomen with endometriosis suffer from sexual dysfunction, especially those aged 31 to 40 years. Our findings suggest that the quality of sexual life in this subpopulation needs to be improved.