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目的 研究腹腔镜下盆腔子宫内膜异位症 (EM )的各种外观形态表现及相应的组织学特点。方法 对 88例不孕症患者在腹腔镜二氧化碳人工气腹下进行盆腔检查 ,对典型或不典型子宫内膜异位病损拍照记录 ,病损部位行组织学检查或行内凝热 -色试验 (heat -colourtest,HCT)。结果 腹腔镜下发现的盆腔EM外观表现有以下类型 :①典型病损 :包括色素型病损、出血型病损及腺体样结构。②不典型病损 :包括水泡病损、微细病损及血管增生病损。③隐匿性病损 :在腹腔CO2 充气 (约 30分钟 )后方可显示出点状或斑片状出血灶。④疤痕性病损 :白色斑块及腹膜缺损。 39例盆腔EM患者的 44处病损行活组织检查 ,2 8处见子宫内膜上皮、腺体和间质或含铁血黄素 ,组织学检查诊断EM的阳性率达 6 4% ,未行组织学检查的上述病损HCT均阳性。结论 盆腔EM的形态具多样性 ,腹腔镜放大作用及CO2 气腹有助于不典型和隐匿性病损的发现和显示。组织学证据表明EM的多种外观表现与病损在发生发展中所处的阶段及活动性有关
Objective To study the appearance and histological features of laparoscopic pelvic endometriosis (EM). Methods 88 cases of infertility patients underwent laparoscopic artificial pneumoperitoneum pneumoperitoneum pelvic examination of typical or atypical endometriosis lesions take pictures, histological examination of lesions or in-line heat-color test heat-coourtest, HCT). Results Laparoscopic findings of pelvic EM showed the following types of appearance: ① typical lesions: including pigmented lesions, bleeding lesions and gland-like structures. ② atypical lesions: including blister lesions, micro-lesions and vascular proliferation lesions. ③ Occult lesions: in the peritoneal CO2 inflatable (about 30 minutes) before showing punctate or patchy hemorrhage. ④ scar lesions: white plaque and peritoneal defects. Forty-four lesions in 39 patients with pelvic EM were examined by biopsy, 28 cases of endometrial epithelium, glands and interstitial or hemosiderin, 28 cases were diagnosed by histological examination, the positive rate of EM was 64% Histological examination of the above lesions were positive for HCT. Conclusions The morphology of pelvic EMs is diverse. Laparoscopic magnification and CO2 pneumoperitoneum contribute to the discovery and display of atypical and occult lesions. Histological evidence shows that multiple appearances of EM are related to the stage and activity of the lesion during its development