What Are the Pros and Cons of Surgery for Endometriosis?

Endometriosis is a common gynecological disease in women that occurs when active endometrial cells are planted outside the endometrium. Endometrial cells should have grown in the uterine cavity, but because the uterine cavity communicates with the pelvic cavity through the fallopian tube, the endometrial cells can enter the pelvic cavity through the fallopian tube to grow ectopically. At present, there are many opinions on the mechanism of this disease. Among them, the endometrial implantation theory is widely accepted. This disease mostly occurs in women of reproductive age, does not develop before puberty, and ectopic lesions can gradually shrink and degenerate after menopause.

Basic Information

English name

endometriosis

Visiting department

Gynecology

Common locations

uterus

Common causes

Endometrial implantation, deficiency in immune defense function, genetic and physical factors, endocrine dysfunction

Common symptoms

Dysmenorrhea, abnormal menstruation, infertility, pain during intercourse, etc.

Causes of endometriosis

Planting theory

Menstrual flow countercurrent, endometrial implantation. During menstruation, menstrual blood flows down from the cervix and vagina, but a small part of menstrual blood or other endometrial fragments are mixed with it, which flows into the abdominal cavity through the fallopian tube. Endometriosis.

2.Chemical endometrium

Serous epithelium, metaplasia. During human embryonic development, ovarian surface epithelium, peritoneum, vaginal rectum, and umbilicus are all metaplastic from body cavity epithelium. These tissues can be transformed under the stimulation of gonadal hormones, inflammation, and mechanical factors to form another tissue. Can be transformed into endometrium.

3. Benign transfer

Benign metastasis of blood and lymph. This is a relatively rare cause. Endometriosis, which occurs in the lungs, meninges, pericardium, extremities, and other distal areas, is caused by endometrial debris transferred to and retained on certain organs or tissues through the blood circulation or lymphatic system.

4. Iatrogenic endometrial transplantation

This is a kind of artificial endometrial transplantation to some parts, more common in cesarean section, early and mid-term pregnancy, curettage, perineal incision during delivery, abortion and other processes.

5. Deficiency of immune defense function

The endometrium with menstrual blood flowing back to the abdominal cavity, like a foreign body, will activate the body's immune system and mobilize a large number of immune cells and body fluids to eliminate it. If the immune function in the body is defective, it will develop into endometriosis .

6. Genetic factors

Endometriosis has a certain genetic predisposition and familial aggregation, and most people with a family history of this disease suffer from this disease.

Clinical manifestations of endometriosis

Symptoms

(1) Dysmenorrhea Dysmenorrhea is the most typical symptom of endometriosis, which is a progressive exacerbation of secondary partners, often starting 1 to 2 days before menstrual cramps, the most dramatic on the first day of menstruation, and then gradually reduced to menstruation Disappears when clean. Severe pain is unbearable, and even analgesics do not work. Pain is caused by local tissue inflammatory response stimulated by internal bleeding in the endometriosis lesion. At the same time, endometriosis lesions increase secretion of prostaglandins, leading to uterine muscle contracture, dysmenorrhea is bound to be more significant.

(2) Abnormal menstruation can be manifested as excessive menstruation or periodic disturbances. Most menstrual abnormalities are related to endometriosis affecting ovarian function. Patients with endometriosis can develop ovarian dysfunction, such as abnormal ovulation

(3) Infertility Patients with endometriosis are often accompanied by infertility. Among patients with endometriosis, the infertility rate is 40% to 50%. Mainly because endometriosis often can cause adhesions around the fallopian tubes to affect oocyte retrieval; or ovulation due to ovarian disease.

(4) Pain during intercourse. Endometriosis with uterine rectal depression and vaginal rectal septum can cause pain during intercourse (deep tenderness), increased defecation during menstrual periods, and pain (heavy after anxiety).

(5) Others Endometriosis to the bladder, there are periodic urinary frequency, dysuria, and hematuria. Abdominal wall scars and endometriosis of the umbilical cord have periodic local masses and pain. Patients with intestinal endometriosis may experience abdominal pain, diarrhea or constipation, and even periodic small amounts of blood in the stool. Ectopic endometrial invasion and compression of the ureter can cause back pain and hematuria on one side, but it is extremely rare.

2. Signs

Gynecological examination may reveal that one or more hard nodules, such as the size of mung beans or soybeans, are obvious in the uterine rectal depression, uterine sacral ligament, or posterior wall of the cervix. The ectopic lesions of the vagina are mostly located in the posterior fornix. Examination shows tenderness nodules in the posterior fornix, and in severe cases, it is dark purple. Ovarian hematoma is often adhered and fixed to the surroundings. During inspection, it can touch the mass with high tension and tenderness. Internal hemorrhage occurs after rupture, which is manifested as acute abdominal pain.

Endometriosis test

Laboratory inspection

(1) CA125 (cancer antigen 125) value determination As a tumor-associated antigen, it has certain diagnostic value for epithelial ovarian cancer. However, in patients with endometriosis, the CA125 value can increase, and with the increase of endometriosis, the positive rate also increases, its sensitivity and specificity are very high, so for endometriosis Diagnosis of the disease can help, and at the same time, the efficacy of endometriosis can be monitored.

(2) Anti-endometrial antibody (EMAb) Anti-endometrial antibody is an autoantibody that takes the endometrium as a target antigen and causes a series of immunopathological reactions, and is a marker antibody for endometriosis. The detection of serum EMAb is an effective method for the diagnosis and efficacy observation of patients with endometriosis.

2. Imaging examination

(1) B-mode ultrasound examination B-mode ultrasound examination is one of the commonly used inspection methods in obstetrics and gynecology, and has an important role in the diagnosis of obstetrics and gynecology diseases. The location, size, and shape of the cysts and the masses that were not touched during the gynecological examination can be determined.

(2) Laparoscopy With the help of laparoscopy, you can directly look at the pelvic cavity, see the ectopic lesions or perform biopsy on the visible lesions to determine the diagnosis, and determine the clinical stage and treatment plan of pelvic endometriosis according to the microscopic examination. . Laparoscopy should pay attention to observe the uterus, fallopian tubes, ovaries, uterine sacral ligaments, pelvic peritoneum and other parts for endometriosis. Endometriosis is staged and scored according to the findings of laparoscopy or surgery.

(3) X-ray examination Feasibility of separate pelvic inflation imaging and uterine fallopian tube lipiodol imaging to help diagnose pelvic endometriosis.

(4) Magnetic Resonance Imaging (MRI) MRI can directly image on multiple planes, intuitively understand the scope, origin and invading structure of the lesion, can correctly locate the lesion, and enhance the ability to display soft tissue. Therefore, MRI is of great value in diagnosing endometriosis and understanding pelvic lesions and adhesions.

Endometriosis diagnosis

According to the characteristics of this disease, women of childbearing age with progressive dysmenorrhea or with infertility history, gynecological examination can be found in the pelvic cavity with inactive mass or painful nodules, generally can be initially diagnosed as pelvic cavity Endometriosis. The diagnosis of endometriosis should be performed in a triad, and if necessary, an examination can be performed in the middle of the menstrual cycle and on the second day of menstruation. Those with slightly more complicated conditions can further diagnose with the help of the above laboratory tests and special examination methods. Should be distinguished from ovarian cancer, fallopian tube ovarian inflammation mass, rectal cancer and so on.

Endometriosis treatment

Treatment options for endometriosis vary depending on the severity of the disease, the age and fertility of the patient. If the condition is severe, or manifests as severe dysmenorrhea, or a positive endometriotic nodule is found on pelvic examination, medication or surgery must be taken.

Drug treatment

Medications are used to counteract or suppress periodic endocrine stimulation of the ovaries. Testosterone androgen was initially used. Due to its large side effects and insufficient potency, it has been gradually abandoned. Later it gradually developed into false pregnancy therapy and false menopause therapy.

(1) False pregnancy therapy Use progestin drugs to take long-term, uninterrupted, larger doses to stop menstruation and endometrium and ectopic endometrium to have pregnancy-like reactions under the action of drugs, so Called fake pregnancy therapy. There are many drugs used for this therapy, and they are still being developed. Oral progesterone, provira, nemetone, etc., and intramuscular progesterone caproate. This treatment must last at least six months before it can stop the ectopic endometrium and eventually atrophy, resulting in a curative effect.

(2) Pseudomenopausal therapy Danazol is a derivative of androgens, which works well, but has relatively large side effects. At present, gonadotropin-releasing hormone agonist (GnRHa) is widely used, commonly known as goserelin, which mainly inhibits the function of the ovaries very strongly, making it almost completely ineffective, and thus achieves the therapeutic purpose. The drug is a long-acting slow-release preparation that requires only subcutaneous injection once a month, which is very convenient. Such drugs can cause endometrium to produce a phenomenon similar to endometrial atrophy in menopausal women, so they are called pseudomenopausal therapy.

2. Surgery

It is generally believed that chocolate cysts that occur on the ovary often have larger lesions or endometriotic nodules in other parts, with a diameter of more than 2 cm, which is not easy to control with drugs and requires surgical treatment; or after six For months or even a year of medication, the condition still does not improve, and surgical resection should also be considered. If the patient is young and has no children, only the endometriotic lesions are removed during surgery, and the uterus and normal ovarian tissue are retained. This is called conservative surgery. This procedure retains the possibility of fertility, but has a greater chance of recurrence. If you have children and the patient is older (greater than 35 years old), you can remove the endometriosis while removing the uterus, but retain normal ovarian tissue, which is called semi-conservative surgery. In the long run, this method is better than conservative surgery, but it cannot absolutely prevent recurrence. If the patient is near menopause, or the endometriosis is too extensive to be completely eradicated, the uterus and ovary should be removed together during the operation, which is called radical surgery.

In recent years, the widespread application of laparoscopy has made a new choice for the treatment of endometriosis, especially abroad. The combination of laparoscopic surgery and GnRHa drugs has become an increasingly extensive treatment plan.

Endometriosis prevention

Marriage of appropriate age

Late-fertility women, especially those with dysmenorrhea, should give birth as soon as possible.

2. Drug contraception

Women who have children or have no birth plan, if they have dysmenorrhea, can choose oral contraceptives, which can prevent contraception and reduce the incidence of endometriosis.

3. Prevent menstrual flow

During menstruation, all intense physical exercise and heavy physical labor are prohibited; sexual life is avoided during menstruation; and cervical adhesions and other diseases complicated by menstrual blood retention are treated as soon as possible.

4. Prevent the occurrence of iatrogenic endometriosis

Care should be taken to protect the wound during cesarean surgery, and to avoid implanting the endometrium into the incision. During an abortion, avoid suddenly lowering the negative pressure to prevent the endometrium from flowing back into the pelvic cavity. Ventilation of the fallopian tubes and water, and uterine fallopian tube imaging should be performed 3 to 7 days after menstruation is clean.