中国实用妇科与产科杂志

中国实用妇科与产科杂志

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腹腔镜诊断盆腔深部浸润型子宫内膜异位症的临床价值

陈淑琴,范莉,金文艳,张焕晓,姚书忠   

  1. 作者单位：中山大学附属第一医院妇产科，广东 广州510080
  • 出版日期:2014-08-02 发布日期:2014-07-23
  • 通讯作者: 姚书忠
  • 基金资助:

    国家自然科学基金（81070472）；广东省科技计划项目（2012B031800121）；广东省人口和计划生育委员会科研项目（20110258）

Distribution characteristics of deep infiltrating endometriosis and evaluation of accuracy of laparoscopic diagnosis.

CHEN Shu-qin, FAN Li, JIN Wen-yan, ZHANG Huan-xiao, YAO Shu-zhong.   

  1. Department of Obstetrics and Gynecology, First Affiliated Hospital of Sun Yat-sen University，Guangzhou 510080，China
  • Online:2014-08-02 Published:2014-07-23

摘要：

目的 探讨盆腔深部浸润型子宫内膜异位症（DIE）病灶分布的特点和腹腔镜诊断的准确性。 方法 收集中山大学附属第一医院2008年8月到2012年5月以DIE为手术指征患者79例，行腹腔镜下子宫内膜异位症根治术，腹腔镜诊断后切除各个部位的DIE病灶。以病理诊断为标准，分别计算腹腔镜诊断不同部位DIE病灶的阳性预测值（PPV）、阴性预测值（NPV）、敏感度（SEN）和特异度（SPE）。结果 取得盆腔DIE病灶组织274份，其中后盆腔242份（88.32%），左侧（27.73%,76/274）多于右侧（24.45%，67/274）。盆腔DIE病灶以骶韧带最常见（39.42%，108/274），依次为直肠（16.06%，44/274）、阴道直肠隔（12.04%，33/274）、阴道后穹窿（9.12%，25/274）。腹腔镜诊断DIE的PPV为98.83%（254/257），SEN为92.70%（254/274）、NPV为45.95%（17/37）、SPE为85%（17/20）。肠壁和阴道后穹窿的诊断符合率最高为100%（47/47和25/25），阴道直肠隔为96.97%（32/33），左、右骶韧带分别为83.64%（46/55）和90.56%（48/53），左、右输尿管分别为83.33%（10/12）和66.67%（4/6）。结论 腹腔镜下诊断盆腔DIE病灶的病理诊断阳性率较高。

关键词: 深部浸润型子宫内膜异位症, 诊断, 腹腔镜检查, 评价研究

Abstract:

Abstract： Objective To determine the characteristics of anatomical distribution of pelvic deep infiltrating endometriosis (DIE), and the correlation between visual and histologic findings of DIE at laparoscopy. Methods 79 patients with DIE underwent radical resection of endometriosis by laparoscopy. Various focus were resected in laparoscopic diagnose during the procedure and sent to pathological examinations. After pathological diagnosis were confirmed, the positive predictive value (PPV), negative predictive value（NPV）, sensitivity（SEN）and specificity（SPE） for different endometriosis lesions diagnosed by laparoscopy were calculated. Results In the 274 focal lesions obtained by laparoscopy, DIE lesions tended to locate in posterior part of the pelvis were 242 (88.32%), and more in the left side (27.73%, 76/274) than right side (24.45%, 67/274). The most focus was uterosacral ligaments DIE (39.42%), rectum DIE (16.06%), rectovaginal septum DIE (12.04%) and posterior fornix DIE (9.12%) was in descending order. The coincidence rate of laparoscopic diagnosis for single DIE lesion was 92.7%, including intestinal wall lesion (100%), posterior fornix lesion (100%), rectovaginal septum lesion (96.97%), left and right uterosacral ligament lesion (83.64% and 90.56%), left and right ureter lesion (83.33% and 66.67%). PPV, SEN, NPV and SPE for diagnosis of DIE confirmed by laparoscope were 98.83%, 92.70%, 45.95% and 85%, respectively. Conclusion According to the pathology, the positive rate of DIE diagnosed by laparoscope is high.

Key words: deep infiltrating endometriosis, diagnosis, laparoscopy, evaluation studies

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