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目的分析腹腔镜下腹膜型子宫内膜异位症的病变特点,评价腹腔镜配合病理诊断子宫内膜异位症的价值。方法对136例临床考虑子宫内膜异位症的患者进行腹腔镜手术,切除异位的病变组织常规送病理检查确实。结果①136例白色病变为82例,黑色病变为34例,红色病变为20例。其中病理确实为子宫内膜异位症的有115例(84.6%),但有21例没有内异症的证据(15.4%),其中100%的红色病变,92%的黑色病变和31%的白色病变病理证实为子宫内膜异位症。②最常见的病变部位是宫骶韧带和阔韧带后叶,依次为侧盆壁腹膜、卵巢窝、卵巢表面、子宫膀胱反折腹膜、输尿管和肠管浆膜面。③在取检的236处异位病变中,210处(89%)病变经组织学证实。腹腔镜和病理的符合率在宫骶韧带是88.2%,阔韧带是94.9%,侧盆壁是91.4%,卵巢窝是100%,膀胱反折腹膜是54.5%,输尿管是70%,肠管浆膜面是33.3%。结论子宫内膜异位症病灶可以形形色色,以白色病变多见,而红色病变的病理符合率最高,不是所有腹腔镜下可疑异位病灶均为子宫内膜异位症;常见的发病部位主要位于宫骶韧带和阔韧带后叶,精确的病理检查配合腹腔镜诊断治疗子宫内膜异位症是必要的。
Objective To analyze the characteristics of laparoscopic peritoneal endometriosis and evaluate the value of laparoscopy combined with pathological diagnosis of endometriosis. Methods 136 cases of endometriosis patients undergoing laparoscopic surgery, removal of ectopic lesions sent to the pathological examination routinely confirmed. Results ① There were 82 cases of white lesions in 136 cases, 34 cases of black lesions and 20 cases of red lesions. Of the 115 cases (84.6%) with endometriosis pathologically, 21 had no evidence of endometriosis (15.4%), of which 100% had red lesions, 92% had black lesions and 31% had endometriosis Pathology of white lesions confirmed endometriosis. ② The most common lesion is uterosacral ligament and broad ligament posterior lobe, followed by peritoneal cavity, ovarian nest, ovarian surface, uterine bladder peritoneum, ureter and intestinal serosal surface. ③ Of the 236 ectopic lesions examined, 210 lesions (89%) were histologically confirmed. The coincidence rate of laparoscopy and pathology was 88.2% in the uterosacral ligament, 94.9% in the broad ligament, 91.4% in the lateral pelvic wall, 100% in the ovarian nest, 54.5% in the retroperitoneal bladder, 70% in the ureter, 70% in the intestinal serosa The face is 33.3%. Conclusion The lesions of endometriosis can be of all kinds, white lesions are more common, while the pathological coincidence rate of red lesions is the highest. Not all laparoscopic suspicious ectopic lesions are endometriosis; the common pathogenesis sites are mainly located in Palace of the sacral ligament and broad ligament posterior lobe, with accurate pathological examination with laparoscopic diagnosis and treatment of endometriosis is necessary.