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目的分析深部浸润型子宫内膜异位症(DIE)的危险因素,为临床的诊疗提供指导。方法选择62例疑诊深部浸润型子宫内膜异位症患者,根据腹腔镜或术后病理结果分为DIE组31例和非DIE组31例,术前详细记录患者的一般资料、病史、临床症状及体征,分析以上指标对深部浸润型子宫内膜异位症的诊断价值。结果两组病程、不孕病史、r-AFS评分及分期在DIE组和非DIE组中,差异均有统计学意义(P<0.05),两组患者的四种常见临床症状,包括严重痛经,小腹疼痛,性交痛及肛门坠胀在DIE组的发生率显著高于非DIE组(P<0.05),其中严重痛经的诊断灵敏度为32.26%,特异度为90.32%;小腹疼痛的诊断灵敏度为51.61%,特异度为74.19%;性交痛的诊断灵敏度为38.71%,特异度为83.87%;肛门坠胀的诊断灵敏度为35.48%,特异度为90.32%。DIE组子宫体积增大,子宫活动度欠佳,附件囊肿活动度欠佳,宫骶韧带触痛阳性,阴道直肠隔结节触痛阳性及后穹窿蓝色结节的发生率显著高于非DIE组(P<0.05),其中子宫体积增大的诊断灵敏度为38.71%,特异度为83.87%;子宫活动度欠佳的诊断灵敏度为58.06%,特异度为74.19%;附件囊肿活动度欠佳的诊断灵敏度为61.29%,特异度为70.97%;宫骶韧带触痛阳性的诊断灵敏度为80.65%,特异度为74.19%;阴道直肠隔结节触痛阳性的诊断灵敏度为100.00%,特异度为90.32%;后穹窿蓝色结节的诊断灵敏度为100.00%,特异度为93.54%。结论病史资料中的一般资料、临床症状和妇科检查对于初步诊断深部浸润型子宫内膜异位症具有较高的临床参考价值,对于出现严重痛经、性交痛及合并妇科检查结节触痛患者高度怀疑深部浸润型子宫内膜异位症,适合临床长期推广应用。
Objective To analyze the risk factors of deep infiltrative endometriosis (DIE) and provide guidance for clinical diagnosis and treatment. Methods Sixty-two patients with suspected deep-invasive endometriosis were selected. According to the results of laparoscopy or postoperative pathology, there were 31 cases in DIE group and 31 cases in non-DIE group. Preoperative detailed records of general information, history, clinical Symptoms and signs, analyze the above indicators of deep infiltrative endometriosis diagnostic value. Results The duration of disease, the history of infertility, r-AFS score and staging in DIE group and non-DIE group were all significantly different (P <0.05). Four common clinical symptoms, including severe dysmenorrhea, The incidence of abdominal pain, intercourse pain and anus bulge in DIE group was significantly higher than that in non-DIE group (P <0.05). The diagnostic sensitivity of severe dysmenorrhea was 32.26% and the specificity was 90.32%. The sensitivity of abdominal pain was 51.61 %, The specificity was 74.19%. The diagnostic sensibility of intercourse pain was 38.71% and the specificity was 83.87%. The diagnostic sensitivity of anus bulge was 35.48% and the specificity was 90.32%. DIE group, uterine volume increased, poor uterine activity, poor appendage cyst activity, uterine sacral ligament tenderness, positive vaginal nodules tenderness and posterior fornix blue nodules were significantly higher than the incidence of non-DIE (P <0.05). The diagnosis sensitivity of uterine volume increase was 38.71% and the specificity was 83.87%. The diagnostic sensitivity of poor uterine motion was 58.06% and the specificity was 74.19%. The activity of accessory cyst was poor The diagnostic sensitivity was 61.29% and the specificity was 70.97%. The diagnostic sensitivity of uterosacral ligament tenderness was 80.65% and the specificity was 74.19%. The diagnostic sensitivity of vaginal and rectal nodular tenderness was 100.00% and the specificity was 90.32 %. The posterior fornix blue nodule had a diagnostic sensitivity of 100.00% and a specificity of 93.54%. Conclusion The general information, clinical symptoms and gynecological examinations in the history data have high clinical value for the preliminary diagnosis of deep infiltrative endometriosis. For the patients with severe dysmenorrhea, painful sexual intercourse and tenderness with gynecological examination nodules Suspected deep infiltration of endometriosis, suitable for long-term clinical application.