endometriosis
Introduction
Introduction Endometriosis refers to a disease caused by the implantation of endometrial tissue with growth ability and function outside the uterine cavity. Endometriosis is a common and frequently-occurring disease in gynecology. It is a benign invasive disease common to women in reproductive stages and is one of the gynecological diseases. The prevalence of middle-aged women is about 15%; the age of onset is mostly between 30-49 years old. The incidence rate of women in reproductive period accounts for 70%-80% of infertility patients, which seriously affects women's physical and mental health, work and childbirth.
Cause
Cause
1. Menstrual disease:
In particular, the menstrual cycle is shortened, the menstrual cycle is frequent, the menstrual flow is large, the menstrual period is too long, and the abdominal pain is caused. These menstrual diseases increase the number and blood volume of menstrual blood flowing from the fallopian tube to the pelvic cavity. Patients with abdominal pain, especially those with severe abdominal pain, especially those with severe abdominal pain, may cause strong contraction of the uterus due to increased secretion of prostaglandins in the blood. At the same time, the menstrual blood flow and endometrial debris are increased. Free chance.
2. Ignore menstrual hygiene:
During menstruation, pelvic congestion, uterine sensitivity, frequency and intensity of contraction increase, if you do not pay attention to emotional conditioning, excessive excitement, nervous irritability, anxiety and fear, overwork, strenuous exercise, body position mutation, especially during the menstrual period, do not avoid sexual intercourse, Unnecessary internal examination of gynecology, or excessive compression, vaginal suppository during menstruation, etc. are likely to increase the chance of blood flow and blood volume.
3. The position of the uterus is not correct:
The normal uterus position is forward leaning forward, in order to facilitate the outflow of menstrual blood. If the uterus is posteriorly inclined, especially in severe cases, it is easy to cause menstrual blood outflow, accumulate uterine cavity, increase the pressure in the uterine cavity, and enter the menstrual blood counterflow. The abdominal cavity creates conditions.
4. genital abnormalities:
Including congenital dysplasia and acquired errors lead to congenital development, such as uterine occlusion, vaginal diaphragm, hymen atresia. The day after tomorrow can be caused by artificial abortion, uterine cavity, vaginal surgery, vaginal medication, etc., the cervix, uterine cervix, vagina, vaginal opening adhesion, menstrual blood can not be excreted, the pressure in the uterine cavity increases, leading to menstrual blood reflux, into the pelvic cavity. Therefore, all suffering If there is a primary or secondary group, the treatment should be checked promptly.
5. Gynecological surgery operation:
Repeated abortions will change the pressure in the uterine cavity and contract the uterus. It is difficult to avoid endometrial debris and blood entering the pelvis through the fallopian tubes. In recent years, the increase in caesarean section has increased the chance of implanting the endometrium in the uterine muscle wall, pelvis, and abdominal wall. The strict regulation of the placement of intrauterine devices and the untimely treatment of postoperative complications can increase the possibility of menstrual blood flow and endometrial implantation.
Examine
an examination
Related inspection
Endometrial biopsy fertility immunosuppressive acidic protein
Women of childbearing age have a history of progressive dysmenorrhea or / and infertility. During gynecological examination, there are tender indurations in the pelvic cavity or inactive cystic masses around the uterus, which can be initially diagnosed as endometriosis.
Auxiliary inspection
1, B-ultrasound: At present, B-ultrasound imaging is an effective method to assist in the diagnosis of endometriosis. The acoustic image of the endometrioid cyst is a small granular echo. If the cystic fluid is viscous and the inner membrane fragments float inside, it is similar to the echo characteristic of the hair contained in the teratoma. Sometimes it is separated internally and divided into There are several sacs of different sizes, and the echoes between the sacs are inconsistent, often sticking to the uterus, and the boundaries between the two are unclear.
2, laparoscopy: laparoscopy is the main method for the diagnosis of endometriosis. Laparoscopy can directly peep into the pelvic cavity, and the ectopic foci can be clearly diagnosed, and can be staged according to the examination, so as to determine the treatment plan.
3, X-ray examination: can do a single pelvic gas angiography, pelvic gas angiography and uterine tubal lipiodol angiography and separate hysterosalpingography, most endometriosis patients have internal genital adhesions and adhesions to the intestines. The ectopic endometrium is most easily implanted in the uterus rectum, so the adhesion of the internal genitalia is likely to occur in the uterus and rectum, making it shallower, especially in the pelvic inflatable contrast lateral radiograph shows more obvious. The fallopian tube ovary can form a blocking mass that is more clearly visible in the radiograph or in the inflated angiography.
Diagnosis
Differential diagnosis
1. Primary dysmenorrhea:
Early endometriosis is easy to be confused with primary dysmenorrhea. Generally, the symptoms of primary dysmenorrhea occur before the bleeding, and the peak reaches several hours after hemorrhage. It disappears within a day or two, and the pain of endometriosis often occurs. Beginning before the menstruation, the whole period is continued, and even until the days after the passage disappears. The former is the pain in the middle of the lower abdomen, and the ectopic disease is blunt pain and falling pain, which can be in the middle or on one side, and is often radiated to the rectum, perineum and lower back. Pelvic examination, if found in small tender nodules, is more conducive to the diagnosis of endometriosis. If there is no typical clinical signs, it can be treated according to functional dysmenorrhea. Laparoscopy should be performed if necessary.
2. Adenomyosis:
The disease has a periodic dysmenorrhea, and the amount of menstrual blood lasts for a long time. Inspection features: irregular uterus, harder quality, B-ultrasound is helpful for diagnosis. Adenomyosis can coexist with pelvic endometriosis.
3. Ovarian tumors:
Liangzhu ovarian cyst examination is generally more active, without dysmenorrhea, no thickening next to the palace, and ovarian chocolate cysts are more limited due to adhesions, often with thickening of the uterus, uterine ligament or uterus can touch the painful nodules . Ovarian cancer can be found in the attachment area with adhesive cysts, and there are nodules in the uterine rectal fossa, but generally no dysmenorrhea, nodular tenderness is not obvious, the disease develops rapidly, the age is too large, the general condition is poor, may be accompanied by ascites. B-ultrasound and serum CAl25 (>100U/m1) examination are helpful for diagnosis, and highly suspicious patients should be diagnosed by laparoscopy as soon as possible.
4. Chronic pelvic inflammatory disease:
Chronic pelvic inflammatory disease may have a history of repeated inflammatory attacks. Tuberculous pelvic inflammatory disease is often accompanied by a history of tuberculosis in other areas, or a decrease in the amount of menstruation, dark or light, with backache. Endometrial pathology shows inflammatory tissue, but endometrial tuberculosis is rare, unless it is advanced. Endometriosis often has dysmenorrhea or painful nodules. Uterine lipiodol angiography shows that the fallopian tube is unobstructed without lesions, and the possibility of endometriosis is large. Tuberculosis often shows typical lesions of the fallopian tube, such as tubal stiffness, beaded or fistula. Ectopic and tuberculosis in the luteal phase of basal body temperature can show low fever, need to be identified by other methods, such as tuberculin intradermal test. Infertility patients with obvious symptoms, and those with difficult diagnosis should be diagnosed by laparoscopy.
5. Acute abdomen:
When the ovarian chocolate cyst ruptures and acute lower abdominal pain occurs, it needs to be differentiated from common acute abdomen. The former has a history of endometriosis, pelvic examination of the parauterine thickening, tender nodules, cysts with adhesions, inactivity, tenderness, and acute pelvic inflammatory disease mostly bilateral lower abdominal pain, accompanied by fever, increased white blood cell count Or with vaginal inflammatory secretions. When the ovarian cyst is reversed, the pelvic cavity is examined for cystic activity, tenderness, often one side, no thickening or nodules. Most of the ectopic pregnancy has menopause, irregular vaginal bleeding, and there may be a mass in the attachment area. The positive pregnancy test is characteristic. Acute appendicitis has metastatic right lower quadrant pain, gastrointestinal symptoms, vomiting, fever, high white blood cells, and tenderness at McPherson. Past medical history, posterior malleolar puncture, B-ultrasound and laparoscopic selection are helpful for differential diagnosis.
