planting theory

coelomic metaplasia theory

induction doctrine

Genetic factors; immune and inflammatory factors; other factors (local microenvironment)

minimal change type

Typical lesion type

In the early stage of the disease, there are scattered purple-brown bleeding spots or scattered granular nodules in the local area of ​​the lesion; as the disease progresses, the posterior wall of the uterus and the anterior wall of the rectum are adherent, and the recto-uterine depression becomes shallower or even disappears completely.

Refers to endometriosis with lesion infiltration depth ≥5mm

Including scar endometriosis (such as abdominal wall incision, perineal incision, etc.) and other rare Distant endometriosis, such as endometriosis in the lungs, pleura, etc.

Pain is the main symptom of endometriosis. Typical symptoms are secondary dysmenorrhea and progressive aggravation.

The infertility rate among patients with endometriosis is as high as 40%

It is more common in those who have ectopic lesions in the recto-uterine pit or who have the uterus fixed in retroversion due to local adhesions.

Pain caused by collision or uterine contraction and lifting during sexual intercourse, usually manifested as deep sexual intercourse pain. Pain during sexual intercourse is most obvious before menstruation

15% to 30% of patients have increased menstrual flow, prolonged menstruation, incomplete menstruation, or premenstrual spotting; this may be related to ovarian parenchymal lesions, anovulation, luteal insufficiency, or the combination of adenomyosis and uterine fibroids.

When there are ectopic endometrium implants growing anywhere outside the pelvic cavity, Periodic pain, bleeding, and lumps may occur locally, and corresponding symptoms may occur.

Ultrasound examination is an important method for diagnosing ovarian ectopic cysts and bladder and rectal endometriosis

Serum CA125 levels may increase. The sensitivity and specificity of CA125 in diagnosing endometriosis are low and cannot be used as an independent diagnostic basis. However, it is helpful for monitoring disease changes, evaluating efficacy and predicting recurrence.

HE4 is mostly at normal levels in endometriosis and can be used in the differential diagnosis of ovarian cancer.

It is currently the best method recognized internationally for the diagnosis of endometriosis. The diagnosis can be confirmed by biopsy of typical lesions or suspicious lesions described in gross pathology under laparoscopy.

The expression levels of serum CA125 and HE4 were significantly increased.

Most of them have a history of acute or recurrent pelvic infection, and the pain is irregular.

Symptoms of dysmenorrhea are usually located in the middle of the lower abdomen and are more severe. The uterus is often uniformly enlarged and hard.

Nonsteroidal anti-inflammatory drugs (NSAIDs)

oral contraceptive pills

progesterone

Gonadotropin-releasing hormone agonist (GnRH-a)

The goal of treatment is to remove the lesion and restore anatomy

Laparoscopic surgery is the preferred surgical method, Currently, laparoscopic diagnosis, surgery + drugs are considered the "gold standard" treatments for endometriosis.

Surgical methods: fertility-preserving surgery; ovarian function-preserving surgery; radical surgery

For patients without infertility or adnexal mass, drug treatment is the first choice

For patients with infertility or adnexal mass, surgical treatment is preferred

First, conduct a comprehensive infertility examination to rule out other infertility factors.

Medication alone is not effective in spontaneous pregnancy

Laparoscopy is the preferred surgical treatment

Young patients with mild to moderate symptoms can expect natural pregnancy for 6 months after surgery and will be given fertility guidance.

The main site of malignant transformation is the ovary, and it is rare in other sites.

In the following clinical situations, you should be alert to the malignant transformation of endometriosis