早期盆腔子宫内膜异位症病灶特点分析

目的腹腔镜下观察子宫内膜异位症的病灶分布及组织学特点，分析经血种植与子宫内膜异位症的关系。方法选择因不孕症进行腹腔镜检查，对早期的典型病灶及可疑病灶进行组织学检查或内凝热-色试验确诊为子宫内膜异位症的患者58例，对其病灶分布特点及组织学特点进行分析。结果病灶分布依次是宫骶韧带87．9％（51／58）、子宫直肠陷凹82．8％（40／58）、阔韧带后叶79、3％（46／58）、卵巢60．3％（35／58）、后子宫浆膜36．2％（21／58）、输卵管25．9％（15／58）、子宫膀胱反折腹膜5．2％（3／58）。患者具有1个病灶占8．6％（5／58），2个及2个以上病灶占91．4％（53／58）。根据组织学特点及病灶外观各类病灶发生的比率依次是出血型病灶84．5％（49／58）、色素型病灶60．3％（35／58）、白色病灶51．7％（30／58）、腺样病灶37．9％（22／58）、水泡病灶25．9％（15／58）、隐匿病灶13．8％（8／58）。以一种病灶出现的有15．5％（9／58）、以2种以上病灶出现率的有84．5％（49／58）。结论盆腔子宫内膜异位症的病灶具有多样性，组织学显示其外观表现是子宫内膜异位症发生发展中的不同阶段，提示可能是经血不断逆流种植形成新的病灶，病灶分布以盆腔后部为主，符合输卵管走向的解剖特点。

Clinical characteristics of early stage of endometrial debris implanting endometriosis

Objective To describe the appearance of various endometriotic lesions under laparoscope and their histological characteristics, and to explore the process of implanted endometrial debris. Methods 58 infertile women were examined by laparoscope. The early-stage pelvic endometriotic lesions were examined by histological method or heat-color test(HCT). Results Lesions were distributed in different parts:87.9 % in utero-sacral ligament; 82.8 % in rectov-aginal space, 79.3 % in broad ligament; 60.3 % in ovary; 36.2 % in oviduct; 25.9 % in retroperitoneal; 5.2 % in vesicouterine fold. 8.6 % of the patients showed one lesion site and 91.4 % two sites. All the pelvic EM lesions could be classified visually into four types by histological examination: blooding lesion(84.5 %), dyeing lesion (60.3 %), white lesion(51.7 %), glandular lesion(37.9 %), pimple lesion(25.9 %), and latent lesion (13.8 %). Conclusion Endometriosis has a multiple appearance, representing different stage of endometriosis. This suggests that implanting of menstrual discharge is continuous process.