Objective To study the significance of pain symptoms and physical signs to diagnosis of deeply infiltrating endometriosis (DIE).Methods Totally 500 patients with laparoscopic diagnosis of endometriosis were studied retrospectively and divided into two groups depending on the existance of DIE.The pain symptoms and gynecological physical signs were recorded detail,and the correlation with diagnose of DIE were analyzed.Results (1) The significance of pain symptoms:the sensitivity,specificity,positive predictive value (PPV),negative predictive value (NPV) and OR,95％ CI of each pain symptom were:dysmenorrhae (90.5％,37.2％,59.6％,79.3％,5.66,3.46-9.28),chronic pelvic pain (35.2％,82.6％,67.4％,55.4％,2.58,1.70-3.91),dyspareunia (46.2％,80.6％,70.7％,59.6％,3.56,2.39-5.32),dyschezia (51.0％,73.7％,66.5％,59.5％,2.91,2.00-4.24),respectively.(2) Pelvic physical examination:the sensitivity,specificity,PPV and NPV of each physical sign were:fixed uterine:73.6％,71.2％,79.5％,64.0％; fixed ovarian cyst:94.1％,20.3％,63.3％,70.0％; uterosacral ligaments nodule:47.1％,97.5％,96.6％,54.9％; uterosacral ligaments nodule with tenderness:81.7％,75.0％,83.1％,73.2％; rectovaginal septum nodule:32.2％,100.0％,100.0％,49.4％; rectovaginal septum nodule with tenderness:32.2％,100.0％,100.0％,49.4％; blue nodule in posterior vaginal forni:14.9％,100.0％,100.0％,43.7％.Conclusions In the symptoms,the dysmenorrheal has the highest sensitivity and NPV for the diagnosis.And chronic pelvic pain has the highest specificity,and dysparaunia has the highest PPV for the diagnosis.In pelvic vaginal examination,fixed uterine,fixed ovarian cyst and the nodule on uretosarcal ligment and rectovaginal septum with tenderness,the blue lesion on posterior fornix have the strong significance for DIE.So record the symptom detail and careful digital vaginal examination,especially the vaginal-recto-abdominal examination could improve the diagnosis DIE obviously before procedure.%目的 评价临床症状和妇科检查对深部浸润型子宫内膜异位症(DIE)术前诊断的意义.方法 选择2009年1月至2012年12月在北京协和医院就诊,因疼痛、卵巢囊肿行腹腔镜手术并确诊为子宫内膜异位症的生育年龄患者共500例.术前详细记录每例患者的各种临床症状、妇科检查和辅助检查结果;对腹腔镜手术中所有可疑的内异症病灶均行手术切除并行病理检查,记录病灶浸润部位、浸润深度等.将患者分为DIE组(253例)和非DIE组(247例),评价临床症状、妇科检查、辅助检查对DIE术前诊断的敏感度、特异度、阳性预测值、阴性预测值及OR值.结果 (1)临床症状对DIE术前诊断的价值:痛经对DIE术前诊断的敏感度、特异度、阳性预测值、阴性预测值、OR值、95％CI分别为90.5％、37.2％、59.6％、79.3％、5.66、3.46～ 9.28.慢性盆腔痛对DIE术前诊断的敏感度、特异度、阳性预测值、阴性预测值、OR直、95％CI分别为35.2％、82.6％、67.4％、55.4％、2.58、1.70～ 3.91;性交痛分别为46.2％、80.6％、70.7％、59.6％、3.56、2.39～5.32;肛门坠胀分别为51.0％、73.7％、66.5％、59.5％、2.91、2.00～4.24.(2)妇科检查对术前诊断DIE的价值:子宫固定不活动对DIE术前诊断的敏感度、特异度、阳性预测值、阴性预测值、OR值、95％ CI分别为73.6％、71.2％、79.5％、64.0％、2.21、1.65～ 2.96;附件囊肿粘连固定分别为94.1％、20.3％、63.3％、70.0％、4.03、1.46～ 11.09;宫骶韧带触痛分别为81.7％、75.0％、83.1％、73.2％、13.36、6.73～ 26.52.宫骶韧带结节对DIE术前诊断的敏感度、特异度、阳性预测值、阴性预测值分别为47.1％、97.5％、96.6％、54.9％;阴道直肠隔结节分别为32.2％、100.0％、100.0％、49.4％;阴道直肠隔结节触痛分别为32.2％、100.0％、100.0％、49.4％;后穹隆蓝色结节分别为14.9％、100.0％、100.0％、43.7％.(3)进一步采用二项分类logistic回归分析上述因素对DIE术前诊断的相关性,得出诊断DIE的回归预测方程.结论 内异症患者术前的各种疼痛症状在诊断DIE中:痛经敏感度最高、阴性预测值最高,慢性盆腔痛的特异度最高,性交痛的阳性预测值最高.术前妇科检查的体征中,子宫固定不活动、附件囊肿粘连固定、宫骶韧带触痛、阴道直肠隔触痛结节、后穹窿蓝色结节对诊断DIE都具有重要的意义.术前详尽的病史收集、仔细的妇科检查,尤其是盆腔三合诊检查能够明显提高DIE的术前诊断率.
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