腹腔镜内凝热-色试验用于诊断盆腔子宫内膜异位症  

Clinical Evaluation on Laparoscopic Diagnosis of Pelvic Endometriosis by Heat Colour Test with Endocoagulation

作　　者：林金芳[1] 孙翠翔[1] 张旭萍[1] 徐先明[1] 于传鑫[1] 

机构地区：[1]上海医科大学妇产科医院

出　　处：《中华妇产科杂志》1997年第5期280-283,共4页Chinese Journal of Obstetrics and Gynecology

摘　　要：目的：评估内凝热－色试验（ＨＣＴ）作为一种诊断盆腔子宫内膜异位症（ＥＭ）方法的临床价值。方法：对８３例不育症患者在腹腔镜下行ＨＣＴ，以诊断ＥＭ。１００℃内凝器探查盆腹膜，棕黑色为ＥＭ阳性。检查结果与直观法和活体组织检查结果进行对照。结果：直观法：８３例中诊断为ＥＭ３５例，未发现ＥＭ４８例。ＨＣＴ法：直观法诊断的３５例ＥＭ可见病灶，ＨＣＴ法检查均为阳性；直观法未发现ＥＭ的４８例中，２０例经ＨＣＴ检查发现无色素的ＥＭ阳性病灶。无色素病损的外观表现包括腹膜充血（７０．９％）、环状腹膜缺损（１２．７％）、半透明水泡样赘生（１０．９％）、白色斑块（１０．９％）、外观正常（５．４％）。其中，１３例共２５处无色素病损经活体组织检查，ＥＭ阳性率为６４．０％（１６／２５）。结论：ＨＣＴ可检测无色素的ＥＭ病灶，核实直观法对盆腔粘连的病因诊断和提高ＥＭ的ＦＩＧＯ分期准确性，是一种可靠、敏感且能准确定位的诊断ＥＭ的新方法，克服了直观法和活体组织检查诊断ＥＭ的多种漏诊因素。Objective: To assess the value of heat colour test (HCT) with endocoagulation under laparoscopy as a new method for diagnosis of pelvic endometriosis (EM). Methods: Laparoscopic visible examination (LVE), lesion biopsy and HCT with endocoagulation were employed for diagnosis of EM in 83 cases of infertility. Brown black colour changes of peritoneal tissue after endocoagulation with controlled heating (100℃) indicate EM implants (HCT positive). Results: LVE indicated that 35 cases had peritoneal lesions typical of EM in appearance. HCT was positive in all cases of visible EM lesions. 48 cases showed no visible peritoneal lesions by LVE, but nonpigmented peritoneal EM lesions were detected by HCT in 20 of the 48 cases. A variety of gross appearances of nonpigmented EM lesions were found in our study including: peritoneal hyperemia (70.9%), circular peritoneal defects (12.7%), semitransparant glandular excrescences (10.9%), white opacification of the peritoneum (10.9%) and normal appearance (5.4%). 25 biopsies were taken from nonpigmented peritoneal lesions in 13 cases. Histology examinations revealed the presence of EM in 64.0% of them. Conclusion: HCT is a reliable, sensitive and accurate method for diagnosis of EM. It can overcome multiple factors for missing diagnosis of EM by LVE and biopsy. The clinical significance of HCT is its ability to detect nonpigmented endometriotic lesions, to differentiate the causes of pelvic adhesions, therefore to increase accuracy of FIGO EM staging under laparoscopy.

关 键 词：子宫内膜异位 腹腔镜 诊断 HCT 

分 类 号：R711.710.4[医药卫生—妇产科学]