子宫内膜异位症患者痛经与病灶分期及特征的相关性  

Relationship between endometriosis stage, characteristics of enodmetriotic lesions and severity of dysmenorrhoea

作　　者：叶明珠[1] 郭红燕[2] 韩劲松[2] 贺豪杰[2] 张坤[2] 熊光武[2] 杨艳[2] 

机构地区：[1]厦门大学附属中山医院妇产科 ,361004 [2] 北京大学第三医院妇产科

出　　处：《中华医学杂志》2015年第9期685-688,共4页National Medical Journal of China

摘　　要：目的 探讨子宫内膜异位症（EM）患者痛经与疾病分期和病变特征之间的相关系.方法 分析北京大学第三医院2013年5至12月经腹腔镜诊断的140例子宫内膜异位症患者的临床资料,术前采用视觉模拟评分法（VAS）进行痛经评分,腹腔镜下观察及记录异位病灶范围及特征,并根据r-AFS进行评分和分期.采用x2检验分析不同程度痛经与临床分期以及与各种术中内异症病灶之间的关系,并对痛经影响因素进行Logistic回归分析.结果 140例中Ⅰ期23例,Ⅱ期10例,Ⅲ期55例,Ⅳ期52例;痛经者95例（67.86％）,无痛经者45例（32.14％）,两组年龄比较差异无统计学意义（P＞0.05）;痛经与初潮间隔平均为（8±9）年,每月痛经持续时间（2.3±1.5）d.痛经程度与子宫内膜异位症分期之间存在相关性,x2=20.677,P＜0.05.痛经程度与子宫直肠陷窝封闭程度有相关性,x2 =8.471,P ＜0.05;不同程度痛经分组中卵巢巧囊发生率、卵巢粘连与否、有无腹膜浅表病灶及深部浸润型子宫内膜异位结节（DIE）均差异无统计学意义,P＞O.05.Logisitic回归分析显示子宫直肠陷窝完全封闭是痛经的独立影响因素,OR=3.291,95％ CI：1.453 ～7.454,卵巢巧囊与痛经程度无相关性.结论 痛经程度与子宫直肠陷窝封闭程度密切相关,与卵巢巧囊关联性较轻.Objective To explore the association between endometriosis stage,characteristics of endometriotic lesions and severity of dysmenorrhoea.Methods The clinical data were collected from 140 patients with laparoscopically diagnosed endometriosis between May 2013 and December 2013.They were scored by visual analogue scale （VAS） according to their preoperative dysmenorrhoea.Endometriotic lesions were recorded by their anatomical distributions.And endometriosis was staged and scored according to the score of Revised American Fertility Society （r-AFS）.The relationship between dysmenorrhoea and endometriosis stage as well as endometriotic foci was analyzed.Chi-square test and Logistic regression were used for statistical analyses.Results Among them,there were 95 （67.86%） patients with dysmenorrhoea and 45 （32.14%） without dysmenorrhoea.No significant inter-group difference existed in age （P 〉 0.05）.The interval from menarche to the onset of dysmenorrhoea was （8 ± 9） years and duration of dysmenorrhoea （2.3 ± 1.5） days each month.A correlation existed between endometriosis stage and severity of dysmenorrhoea （x2 =20.677,P 〈 0.05）.A strong association was found between posterior cul-de-sac obliteration and severity of dysmenorrhoea （x2 =8.471,P 〈 0.05）.No significant difference was found for ovarian endometriomas,ovarian adhesion,superficial peritoneal lesions and deep infiltrating endometriosis in non-and minimal dysmenorrhoea groups with moderate and severe dysmenorrhoea （P 〉 0.05）.Posterior culde-sac obliteration was an independent influencing factor for dysmenorrhoea.The odds ratio （OR） was 3.291 and 95% confidence interval （CI） 1.453-7.454.However,no relevance existed between ovarian endometriomas and dysmenorrhoea by Logistic analysis.Conclusion The severity of dysmenorrhoea has close correlation with posterior cul-de-sac obliteration.However,there is a weak relevance with ovarian endometreaiomas.

关 键 词：子宫内膜异位症 痛经 分期 

分 类 号：R711.71[医药卫生—妇产科学]