复杂子宫内膜异位病治疗中的思考PPT课件.pptx

复杂子宫内膜异位病治疗中的思考历史传统认为：具有生长功能的子宫内膜组织出现在子宫腔以外的身体其它部位，称为子宫内膜异位症。新的观点：内膜异位现象为一种生理情况，只有当异位的内膜反复周期性出血，并出现症状时才是疾病。子宫内膜异位病的定义无症状生育年龄妇女的发病率为2～50％发病率不孕妇女中内异症发病率30％ 慢性盆腔痛的妇女中内异症发病率33％ 临床病理类型腹膜型（PEM）卵巢型（OEM）深部浸润型（DIE）其他部位（OtEM）腹膜深部浸润卵巢异位子宫内膜出现部位什么是复杂的子宫内膜异位病？深部内异结节型（泌尿系统，肠道）复发性子宫内膜异位病有“潜在”生育要求的 复杂在哪里？“重要脏器”的侵犯，如何切除？严重的粘连，如何分离？术后如何防止？保留生育力，如何保留？子宫内膜异位病复杂程度的评估判定子宫内膜异位病严重程度极为重要病史和妇科检查永远是第一位的经阴道超声是首选的无创检查MRI是检查DIE和脏器粘连的金标准卵巢储备功能的检测生育要求的确认病史既往是否有内异病手术史疼痛的类型、特点、程度有无经期咯血、便血、尿血是否有不孕病史是否在短期内有生育要求就诊的目的体检全身检查经期检查为宜其他部位的内异病灶 肺部呼吸音腹部体征直肠指检妇科专科体检外阴检查阴道窥诊双合诊及三合诊（推荐）辅助检查超声MRICA125生殖激素+AMH超声提示kissing ovaries的临床意义阴道超声检查优于妇科检查经阴道超声检查优于经直肠超声检查 Uterine sliding signEvaluate whether the presence of utero-rectal adhesions demonstrated by transvaginal sonography (TVS) could aid as a simple sonographic predictor for deep infiltrating endometriosis of the rectum in patients with symptoms suggestive of endometriosis.29% (34/142) of patients exhibited deep infiltrating endometriosis (DIE) of the bowel. Sensitivity, specificity, PPV, NPV, accuracy, LR+ and LR- for a negative sliding sign as shown by TVS regarding the presence of DIE of the rectum was 85%, 96%, 91%, 94%, 93.1%, 23.6 and 0.15.Hudelist G, Fritzer N, et al. Uterine sliding sign - a simple sonographic predictor for presence of deep infiltrating endometriosis of the rectum. Ultrasound Obstet Gynecol. 2013 Feb 8.MRIMRI检查是筛选或诊断DIE的首选辅助检查方法。可进行全盆腔扫描，是检查盆腔内异多发病灶的最佳非侵入性手段。可以清晰的显示片状和浸润性的病灶，并能测量病灶的大小，是目前认为最有价值的辅助检查手段。也可以通过三维成像来判定脏器之间的粘连情况。浙江省人民医院妇科内镜中心Contrast-enhanced magnetic resonance-colonography (CE-MR-C)Ninety women were enrolled prospectively for suspicion of DIE. All patients underwent CE-MR-C, with each operator blinded to the results of the other exam, before laparoscopy. The global accuracy for CE-MR-C in the detection of DIE was 87.2%, sensitivity was 71.1%, specificity was 97.1%, positive predictive value was 93.7%, negative predictive value was 84.6%, the positive likelihood ratio was 24.4 and the negative likelihood ratio was 0.3. CE-MR-C