子宫内膜异位症患者盆腔粘连与疼痛的相关性

目的 探讨子宫内膜异位症(内异症)患者中盆腔粘连的发生率及其与疼痛症状的相关性. 方法 分析2003年1月至2007年12月间480例内异症患者盆腔粘连及痛经、慢性盆腔痛(CPP)、性交痛与排便痛的发生情况,评价内异症患者的盆腔粘连与疼痛症状之间的相关性.根据美国生育学会1985年修订的内异症分期标准(r-AFS)分为Ⅰ期155例,Ⅱ期33例,Ⅲ期108例,Ⅳ期184例. 结果 (1)480例内异症患者中,72.3%(347/480)存在盆腔粘连;Ⅰ期25.2%(39/155),Ⅱ期78.8%(26/33),Ⅲ期90.7%(98/108),Ⅳ期100.0%(184/184),且盆腔粘连程度与内异症的临床期别间呈正相关关系(rs=0.870,P<0.01);(2)480例内异症患者中,伴痛经者占61.0%(293/480),其中轻、中、重度痛经分别为52.2%(153/293)、26.6%(78/293)、21.2%(62/293);伴CPP者占23.8%(114/480),伴性交痛者占15.4%(74/480),伴排便痛者占7.1%(34/480);(3)卵巢粘连与痛经和CPP呈正相关关系(rs=0.367、0.267,P<0.01);子宫底后壁粘连与痛经和CPP呈正相关关系(rs=0.336、0.164,P<0.01);输卵管粘连与痛经、CPP和排便痛均呈显著正相关关系(rs=0.283、0.225、0.159, P<0.01);直肠粘连与痛经呈正相关关系(rs=0.101,P<0.05).除性交痛外,内异症患者的盆腔粘连程度与其痛经、CPP及排便痛均呈正相关关系(rs=0.470、0.273、0.132、P<0.01).结论 盆腔粘连是内异症的特征性病变,粘连部位及程度与疼痛症状密切相关.

Correlation between pelvic adhesions and pain symptoms of endometriosis

Objective To study the incidence of pelvic adhesions in endometriosis(EM) and the relationship between pelvic adhesions and pain symptoms. Methods The incidence of pelvic adhesions, dysmenorrhea, chronic pelvic pain, dyspareunia, dyschizia in 480 patients with EM were studied retrospectively to evaluate the correlation between pelvic adhesions and the degree of pain symptoms. In accordance with the revised American Fertility Society classification (r-AFS), it was observed that 155 cases were in Stage Ⅰ,33 cases were in stage Ⅱ,108 cases were in stage Ⅲ and 184 were cases in stage Ⅳ. Results (1) Among 480 cases with EM, 72.3% (347/480) of patients have pelvic adhesions simultaneously, of which 25.2% (39/155) patients were in Stage Ⅰ, 78.8% (26/33) patients were in Stage Ⅱ, 90.7% (98/108) patients were in Stage Ⅲ and 100.0% (184/184) patients were in Stage Ⅳ. It was found that positive correlation existed between the degree of pelvic adhesions and clinical staging of EM(rs=0.870,P<0.01).(2) 61.0%(293/480) of patients presented dysmenorrhoea, of which the percentages of mild, moderate and severe dysmenorrhea were 52.2%(153/293), 26.6%(78/293), 21.2% (62/293), respectively. The rate of patients presenting chronic pelvic pain (CPP), dyspareunia and dyschezia were 23.8% (114/480), 15.4% (74/480) and 7.1% (34/480), respectively. (3) Ovarian adhesions was positively correlated with dysmenorrhea and CPP(rs=0.367 and 0.267,P<0.01). Adhesion of the bottom and posterior wall of uterus was positively correlated with dysmenorrhea and CPP (rs=0.336, 0.164,P<0.01); adhesions of fallopian tubes were positively correlated with dysmenorrhea, CPP and dyschezia (rs=0.283, 0.225 and 0.159, P<0.01). Adhesions of rectum was positively correlated with dysmenorrhea (rs=0.101,P<0.05). In addition to dyspareunia, the degree of pelvic adhesions was positively correlated with dysmenorrhea, CPP and dyschezia (rs=0.470, 0.273, 0.132, P<0.01). Conclusion Pelvic adhesions are characteristic lesions of endometriosis, the site and degree pelvic adhesions are closely correlated with pain symptoms.