卵巢子宫内膜异位囊肿合并深部浸润型子宫内膜异位症的腹腔镜手术与病理诊断符合情况分析  

Concordance between laparoscopic diagnosis and pathological diagnosis in ovarian endometriosis with deep infiltrating endometriosis

作　　者：李骁 郭红伶[3] 姜红叶 马颖[1] LI Xiao;GUO Hongling;JIANG Hongye;MA Ying(Department of Obstetrics and Gynecology,the Pearl River Hospital,Southern Medical University,Guangzhou 510260,China;Department of Obstetrics and Gynecology,the Sixth Affiliated Hospital of Sun Yat-sen University,Guangzhou 510650,China;Department of Obstetrics and Gynecology,the Seventh Affiliated Hospital of Sun Yat-sen University,Guangzhou 518107,China;Department of Obstetrics and Gynecology,the First Affiliated Hospital of Sun Yat-sen University,Guangzhou 510080,China)

机构地区：[1]南方医科大学珠江医院妇产科,广东广州510260 [2]中山大学附属第六医院妇产科,广东广州510650 [3]中山大学附属第七医院妇产科,广东广州518107 [4]中山大学附属第一医院妇产科,广东广州510080

出　　处：《新医学》2024年第11期879-884,共6页Journal of New Medicine

基　　金：广东省自然科学基金(2022A1515011880,2023A1515011688);南方医科大学珠江医院院长基金(yzjj2022ms18)。

摘　　要：目的探讨卵巢子宫内膜异位囊肿(OEM)合并深部浸润型子宫内膜异位症(DIE)患者手术切除DIE病灶的病理诊断符合情况。方法回顾性分析304例OEM合并DIE患者的临床资料,患者均以OEM为手术指征,腹腔镜手术中发现DIE病灶,观察患者术中DIE的分布部位和分布特点,并分析不同部位腹腔镜下诊断DIE病灶与病理诊断符合率。结果304例OEM合并DIE患者,腹腔镜手术中共发现DIE病灶995个,其中分布于骶韧带的病灶最多,为489个(49.2%),依次为宫颈阴道直肠间隙及周围病灶131个(13.2%)、直肠乙状结肠病灶93个(9.4%)、输尿管病灶66个(6.6%)。病理诊断见子宫内膜间质和腺体788个,病理诊断符合率为79.2%(788/995),其中肠壁病灶诊断符合率最高,可达100%,子宫骶韧带病理诊断符合率为77.7%,输尿管子宫内膜异位症病灶病理诊断符合率为81.8%。以病理诊断为金标准,腹腔镜诊断DIE的阳性预测值为79.2%(788/995),灵敏度为79.2%(788/995),阴性预测值为85.0%(17/20),特异度为7.9%(17/224)。结论对于OEM合并DIE,腹腔镜诊断DIE与病理诊断符合率高,OEM常合并DIE病灶,可于腹腔镜手术中诊断并切除DIE病灶。Objective To explore the coincidence rate between laparoscopic diagnosis and pathological diagnosis of ovarian endometriosis(OEM)combined with deep infiltrating endometriosis(DIE).Methods The clinical data of 304 patients with OEM combined with DIE were retrospectively analyzed.They all used OEM as the surgical indication.DIE lesions were found during laparoscopic surgery.The distribution of DIE during the operation was observed,including distribution locations and distribution characteristics,and compared.The coincidence rate between laparoscopic diagnosis of DIE lesions in different parts and pathological diagnosis.Results In 304 OEM patients with DIE,a total of 995 DIE lesions were removed during laparoscopic surgery,of which 489(49.2%)were located in the sacral ligament,followed by:a total of 131 lesions(13.2%)in the cervicovaginal and rectal space and surrounding areas,93 rectosigmoid lesions(9.4%),and 66 ureteral lesions(6.6%).Pathological diagnosis showed endometrial stroma and glands in 788 cases,with a pathological coincidence rate of 79.2%(788/995).Among them,the diagnostic coincidence rate of intestinal wall lesions was the highest,reaching 100%,and the diagnostic coincidence rate of sacral ligament was 77.7%,the ureteral endometriosis lesions were 81.8%.Compared with pathological diagnosis,the positive predictive value of laparoscopic diagnosis of DIE was 79.2%(788/995),sensitivity was 79.2%(788/995),negative predictive value was 85.0%(17/20),and spectificity was 7.9%(17/224).Conclusion The coincidence rate between laparoscopic diagnosis of DIE and pathological diagnosis is high.OEM is often associated with DIE lesions,and DIE lesions can be diagnosed and removed during laparoscopic surgery.

关 键 词：子宫内膜异位症 腹腔镜 手术治疗 病理 诊断 

分 类 号：R713.4[医药卫生—妇产科学]