目的:探讨临床症状和妇科检查对深部浸润型子宫内膜异位症(deep invasive endometriosis,DIE)的评估价值.方法:选取2015年1月至2016年12月我院收治的子宫内膜异位症患者120例为研究对象,所有患者均在我院行腹腔镜手术治疗并进行病理检查,以手术病理结果为金标准分为DIE组57例和非DIE组63例,然后与术前患者临床症状和妇科检查结果进行对比分析,评估临床症状和妇科检查对DIE的诊断价值.结果:根据美国生殖医学协会(r-AFC)制定的子宫内膜异位症分期评分标准,DIE组患者病程和r-AFC评分明显高于非DIE组,比较差异有统计学意义(P＜0.05);重度痛经、盆腔痛、性交痛、肛门坠胀等临床症状的诊断灵敏度分别为92.98％、40.35％、66.67％和31.59％;特异度分别为66.67％、71.43％、88.89％和71.43％.子宫大小、子宫活动度、附件囊肿活动度、宫骶韧带结节、宫骶韧带触痛阳性、阴道直肠隔结节、阴道直肠隔触痛阳性、后穹窿蓝色结节等妇科检查项目的诊断灵敏度分别为40.35％、63.16％、73.68％、68.42％、85.96％、14.04％、12.28％和40.35％;特异度分别为63.49％、55.56％、57.14％、80.95％、71.43％、100％、100％和100％.结论:重度痛经、阴道直肠隔结节和后穹窿蓝色结节对诊断DIE具有较高的价值,临床表现和妇科检查发现以上症状,应高度警惕DIE的可能.%Objectives:To evaluate the value of clinical symptoms and gynecological examination of deep invasive endometriosis (DIE).Methods:120 patients with endometriosis admitted in our hospital from January 2015 to December 2016 were as research object.All patients received abdominal mirror surgery treatment and pathology check.The surgery pathology results were as gold standard.The patients were divided into DIE group (57cases) and non-DIE group (63 cases).The clinical symptoms and gynecological check results before operation were compared to assess diagnosis value of clinical symptoms and gynecological check on DIE.Results:According to the endometrial ectopic stage score developed by the American Society for Reproductive Medicine (r-AFC),course and r-AFC score of DIE group were significantly higher than these of non-DIE group,with statistically significant difference (P ＜0.05).The diagnostic sensitivity of severe dysmenorrhea,pelvic pain,pain during sex and anus bulge were 92.98％,40.35％,66.67％ and 31.59％,while specificity was 71.43％,66.67％ and 71.43％,respectively.The sensitivity of size of the uterus,uterine activity,annex cyst activity,uterosacral ligament nodules,positive uterosacral ligament tenderness,vagina and rectum nodules,positive rectovaginal septum tenderness,and posterior FORNIX blue nodule were 40.35％,63.16％,73.68％,68.42％,85.96％,14.04％,and 40.35％;Specificity were 63.49％,55.56％,57.14％,80.95％,71.43％,100％,and 100％.Conclusion:Severe dysmenorrhea,vaginal-rectal septum nodules and posterior FORNIX blue nodule has a high diagnosis value of DIE,so once clinical manifestations and gynecological examination revealed these symptoms,DIE should be paid high attention to.
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