بررسی و مقایسه علائم بالینی و یافته‌های سونوگرافی در بیماران با تشخیص هیستوپاتولوژیک اندومتریوز تخمدانی

نوع مقاله : اصیل پژوهشی

نویسندگان

1 دانشجوی پزشکی عمومی، کمیته تحقیقات دانشجویی، دانشگاه علوم پزشکی بابل، بابل، ایران.

2 استاد گروه زنان و مامایی، مرکز تحقیقات بهداشت باروری و ناباروری، پژوهشکده سلامت، دانشگاه علوم پزشکی بابل، بابل، ایران. استاد گروه زنان و مامایی، دانشکده پزشکی، دانشگاه علوم پزشکی بابل، بابل، ایران.

3 کارشناس ارشد آمار، واحد توسعه تحقیقات بیمارستان آیت‌اله روحانی، دانشگاه علوم پزشکی بابل، بابل، ایران.

4 استادیار گروه رادیولوژی، دانشکده پزشکی، دانشگاه علوم پزشکی بابل، بابل، ایران.

5 دانشیار گروه آسیب‌شناسی، واحد توسعه تحقیقات بیمارستان آیت‌اله روحانی، دانشگاه علوم پزشکی بابل، بابل، ایران. دانشیار گروه آسیب‌شناسی، دانشکده پزشکی، دانشگاه علوم پزشکی بابل، بابل، ایران.

چکیده

مقدمه: سونوگرافی، جهت بررسی شک به وجود آندومتریوز تخمدانی و نیز ارزیابی پاتولوژی، جهت تأیید اندومتریوز انجام می­ شود. ترکیبی از روش­ های تشخیصی، جهت جمع‌بندی و شروع درمان اندومتریوز با اهمیت است. مطالعه حاضر با هدف بررسی و مقایسه تشخیص ­های بالینی و سونوگرافی در بیماران با تشخیص هیستوپاتولوژیک اندومتریوز انجام شد.
روش‌کار: این مطالعه گذشته­ نگر در سال 1400-1390 بر روی 140 نفر از زنان 65-18 ساله مبتلا به اندومتریوز تخمدانی، مراجعه­ کننده به بیمارستان آیت­اله روحانی شهر بابل انجام شد. تأیید اندومتریوز تخمدانی بر اساس پاتولوژی بافت و سپس مقایسه شرح‌حال بالینی با یافته ­های سونوگرافی انجام شد. ابزار گردآوری داده‌ها، پرونده بیماران و چک‌لیست محقق ساخته بود. داده‌های گردآوری شده شامل: تظاهرات بالینی، وجود یا عدم وجود درد هنگام قاعدگی، درد شکم، درد هنگام نزدیکی، درد لگنی، خونریزی قاعدگی غیرطبیعی، کمردرد، درد هنگام دفع مدفوع و سوزش ادرار بودند. تجزیه و تحلیل داده­ ها با استفاده از نر­م­افزار آماری SPSS (نسخه 22) و آزمون‌های کای­ دو و تی تست ­مستقل انجام شد. میزان p کمتر از 05/0 معنی‌دار در نظر گرفته شد.
یافته ­ها: درد هنگام قاعدگی (63/55%)، درد شکم (59/48%) و درد هنگام نزدیکی (69/31%) به‌ترتیب شایع‌ترین علائم بالینی بودند. در سونوگرافی، وضعیت اکوژنیسیتی رحم در 99 بیمار (7/69%) هموژن و در 43 بیمار (3/30%) هتروژن گزارش شد. وضعیت اکوژنیسیتی با درد شکم (004/0=p) و خونریزی قاعدگی غیرطبیعی (032/0=p)، آدنومیوز رحم با درد شکم (004/0=p) و خونریزی قاعدگی غیرطبیعی (032/0=p)، چسبندگی تخمدانی با شکایت درد هنگام نزدیکی (002/0=p) و وضعیت لوله‌های فالوپ با شکایت درد هنگام نزدیکی (015/0=p) و سوزش ادرار (049/0=p) ارتباط معنی‌داری داشتند.
نتیجه ­گیری: درد هنگام قاعدگی، درد شکم، درد هنگام نزدیکی، خونریزی قاعدگی غیرطبیعی و سوزش ادرار با یافته­ های سونوگرافی اختلاف معنی‌داری داشتند. جهت تشخیص قطعی و درمان مناسب؛ تظاهرات بالینی، پاتولوژی و سونوگرافی بیماران می ­بایست بررسی و بر اساس آن درمان انجام شود.

کلیدواژه‌ها

عنوان مقاله [English]

Investigation and Comparison of Clinical Symptoms and Ultrasound Findings in Patients with Histopathological Diagnosis of Ovarian Endometriosis

نویسندگان [English]

  • Aref Shekandeh 1
  • Shahla Yazdani 2
  • Hemmat Gholinia Ahangar 3
  • Hossein Shahabandaz 4
  • Mohammad Ranaee 5
1 General Medicine Student, Student Research Committee, Babol University of Medical Sciences, Babol, Iran.
2 Professor, Department of Obstetrics and Gynecology, Fertility and Infertility Health Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, Iran. Professor, Department of Obstetrics and Gynecology, Faculty of Medicine, Babol University of Medical Sciences, Babol, Iran.
3 M.Sc. of Statistics, Ayatoolah Rouhani Hospital Research Development Unit, Babol University of Medical Sciences, Babol, Iran.
4 Assistant Professor, Department of Radiology, Faculty of Medicine, Babol University of Medical Sciences, Babol, Iran.
5 Associate Professor, Department of Pathology, Ayatoolah Rouhani Hospital Research Development Unit, Babol University of Medical Sciences, Babol, Iran. Associate Professor, Department of Pathology, Faculty of Medicine, Babol University of Medical Sciences, Babol, Iran.
چکیده [English]

Introduction: Ultrasound is performed to check the growth of endometrial cells outside the uterus and the pathology is performed to confirm endometriosis. A combination of diagnostic methods is important for summarizing and starting treatment of endometriosis. The present study was performed with aim to investigate and compare clinical and ultrasound diagnoses in patients with histopathological diagnoses of endometriosis.
Methods: This retrospective study was conducted in 2010-2021 on 140 women aged 18-65 years old suffering from endometriosis referred to Ayatollah Rouhani Hospital in Babol city. Confirmation of endometriosis was done based on tissue pathology and then comparing clinical history with ultrasound findings. The data collection tools were the patients' files and the researcher made checklist. Collected data included clinical manifestations, presence or absence of pain during menstruation, abdominal pain, pain during intercourse, pelvic pain, abnormal menstrual bleeding, backache, pain during defecation, and dysuria. Data were analyzed by SPSS software (version 22) and chi-square and independent t-tests. P<0.05 was considered statistically significant.
Results: Dysmenorrhea (55.63%), abdominal pain (48.59%), and dyspareunia (31.69%) were the most common clinical symptoms. The state of uterine echogenicity was reported to be homogeneous in 99 patients (69.7%) and heterogeneous in 43 (30.3%). Echogenic status had a significant relationship with abdominal pain (p=0.004) and abnormal menstrual bleeding (p=0.032), adenomyosis with abdominal pain (p=0.004), ovarian adhesion with complaints of pain during intercourse (p=0.002) and status of fallopian tubes with complaints of pain during intercourse (p=0.015) and dysuria (p=0.049).
Conclusion: Dysmenorrhea, abdominal pain, dyspareunia, abnormal menstrual bleeding, and dysuria had significant difference with ultrasound findings. For definitive diagnosis and appropriate treatment, clinical manifestations, pathology, and ultrasound should be considered and treatment should be carried out based on that.

کلیدواژه‌ها [English]

  • Clinical Findings
  • Histopathology
  • Ovarian Endometriosis
  • Ultrasound

مراجع

  1. Raimondo D, Raffone A, Renzulli F, Sanna G, Raspollini A, Bertoldo L, et al. Prevalence and Risk Factors of Central Sensitization in Women with Endometriosis. Journal of Minimally Invasive Gynecology 2023; 30(1):73-80.
  2. Eskenazi B, Warner ML. Epidemiology of endometriosis. Obstetrics and gynecology clinics of North America 1997; 24(2):235-58.
  3. Ajossa S, Mais V, Guerriero S, Paoletti AM, Caffiero A, Murgia C, et al. The prevalence of endometriosis in premenopausal women undergoing gynecological surgery. Clinical and Experimental Obstetrics & Gynecology 1994; 21(3):195-7.
  4. Helou CM, Zhao Z, Ding T, Anderson TL, Harvey LF. Should body mass index replace age to drive the decision for endometrial sampling in premenopausal women with abnormal uterine bleeding?. Gynecological Endocrinology 2022; 38(5):432-7.
  5. Gruppo italiano per lo studio dell'endometriosi*. Endometriosis: prevalence and anatomical distribution of endometriosis in women with selected gynaecological conditions: results from a multicentric Italian study. Human Reproduction 1994; 9(6):1158-62.
  6. Jenkins SU, Olive DL, Haney AF. Endometriosis: pathogenetic implications of the anatomic distribution. Obstetrics and gynecology 1986; 67(3):335-8.
  7. Redwine DB. Ovarian endometriosis: a marker for more extensive pelvic and intestinal disease. Fertility and sterility 1999; 72(2):310-5.
  8. Vercellini P. Endometriosis: what a pain it is. InSeminars in reproductive endocrinology 1997; 15(3):251-61).
  9. Pritts EA, Taylor RN. An evidence-based evaluation of endometriosis-associated infertility. Endocrinology and Metabolism Clinics 2003; 32(3):653-67.
  10. Sharpe-Timms KL. Defining endometrial cells: the need for improved identification at ectopic sites and characterization in eutopic sites for developing novel methods of management for endometriosis. Fertility and sterility 2005; 84(1):35-7.
  11. Guzick DS, Silliman NP, Adamson GD, Buttram Jr VC, Canis M, Malinak LR, et al. Prediction of pregnancy in infertile women based on the American Society for Reproductive Medicine's revised classification of endometriosis. Fertility and sterility 1997; 67(5):822-9.
  12. Adamson GD. Endometriosis classification: an update. Current Opinion in Obstetrics and Gynecology 2011; 23(4):213-20.
  13. Fedele L, Bianchi S, Zanconato G, Raffaelli R, Berlanda N. Is rectovaginal endometriosis a progressive disease?. American journal of obstetrics and gynecology 2004; 191(5):1539-42.
  14. Králíčková M, Laganà AS, Ghezzi F, Vetvicka V. Endometriosis and risk of ovarian cancer: what do we know?. Archives of gynecology and obstetrics 2020; 301:1-10.
  15. Hermens M, van Altena AM, van der Aa M, Bulten J, van Vliet HA, Siebers AG, et al. Endometrial cancer prognosis in women with endometriosis and adenomyosis: a retrospective nationwide cohort study of 40 840 women. International Journal of Cancer 2022; 150(9):1439-46.
  16. Rogers PA, D’Hooghe TM, Fazleabas A, Giudice LC, Montgomery GW, Petraglia F, et al. Defining future directions for endometriosis research: workshop report from the 2011 World Congress of Endometriosis in Montpellier, France. Reproductive sciences 2013; 20(5):483-99.
  17. Nisenblat V, Bossuyt PM, Farquhar C, Johnson N, Hull ML. Imaging modalities for the non‐invasive diagnosis of endometriosis. Cochrane Database of Systematic Reviews; 2016(2):CD009591.
  18. Movahed F, Javadi A, Gholami H, Najitehrani A. The validity of transvaginal sonography in the measurement of endometrial thickness. Journal of Advances in Medical and Biomedical Research; 2011; 19 (77):107-14
  19. Cong Q, Luo L, Fu Z, Lu J, Jiang W, Sui L. Histopathology of women with non-uniform endometrial echogenicity and risk factors for atypical endometrial hyperplasia and carcinoma. American Journal of Translational Research 2021; 13(5):4500-09.
  20. Abou Elela NK, Suliman MM, Soliman DM, Zaki SA, Ibrahim RA, Mohammed MG. Utilization of Pelvic Ultrasonography and CA125 Level to Diagnose Uterine Myoma and Adenomyosis. The Egyptian Journal of Hospital Medicine 2022; 88(1):3206-12.
  21. Bergwerff J, Schreurs AM, Lier MC, van Waesberghe JH, van der Houwen LE, Mijatovic V. Measuring intraobserver and intermethod reliability of endometriotic cyst volumes: A comparison between MRI and 3D transvaginal ultrasound in endometriosis. Journal of Endometriosis and Pelvic Pain Disorders 2022; 14(2):80-6.
  22. Saha AK, Suresh A, Eipe T, Nair N. Hydrosalpinx with adhesion colic: a case report. Annals of the Romanian Society for Cell Biology 2021: 9489-91.
  23. Latthe P, Mignini L, Gray R, Hills R, Khan K. Factors predisposing women to chronic pelvic pain: systematic review. Bmj 2006; 332(7544):749-55.
  24. Kendel NE, Stanek JR, Haamid FW, Powers JM, O'Brien SH. Emergency Department evaluation of abnormal uterine bleeding in US children's hospitals. Journal of Pediatric and Adolescent Gynecology 2022; 35(3):288-93.
  25. Aflatoonian A, Mashayekhy M. Transvaginal ultrasonography in female infertility evaluation. Donald School Journal of Ultrasound in Obstetrics and Gynecology 2011; 5(3):311-6.
  26. Collins BG, Ankola A, Gola S, McGillen KL. Transvaginal US of endometriosis: looking beyond the endometrioma with a dedicated protocol. Radiographics 2019; 39(5):1549-68.
  27. Ashraf F, Zafar H, Naz M, Fatima U, Fatima A. Comparison of Endometrial sampling with pipelle versus conventional dilatation and curettage in abnormal uterine bleeding. The Professional Medical Journal 2021; 28(09):1234-8.
  28. Bilotas MA, Olivares CN, Ricci AG, Baston JI, Bengochea TS, Meresman GF, et al. Interplay between endometriosis and pregnancy in a mouse model. PloS one 2015; 10(4):e0124900.
  29. Kadivar M, Vafa A, Farahzadi A, Khani S. 6 years evaluation of prevalence of abdominal wall endometriosis in patients with definite histopathological diagnosis of endometriosis admitted in Rasool-Akram, Shariati and Atieh Hospitals in Tehran. Razi Journal of Medical Sciences 2012; 18(93):20-6.
  30. Eskenazi B, Warner M, Bonsignore L, Olive D, Samuels S, Vercellini P. Validation study of nonsurgical diagnosis of endometriosis. Fertility and sterility 2001; 76(5):929-35.
  31. Van den Bosch T, Van Schoubroeck D. Ultrasound diagnosis of endometriosis and adenomyosis: State of the art. Best Practice & Research Clinical Obstetrics & Gynaecology 2018; 51:16-24.
  32. Salmeri N, Farina A, Candiani M, Dolci C, Bonavina G, Poziello C, et al. Endometriosis and Impaired Placentation: A Prospective Cohort Study Comparing Uterine Arteries Doppler Pulsatility Index in Pregnancies of Patients with and without Moderate-Severe Disease. Diagnostics 2022; 12(5):1024.
  33. Martire FG, Lazzeri L, Conway F, Siciliano T, Pietropolli A, Piccione E, et al. Adolescence and endometriosis: symptoms, ultrasound signs and early diagnosis. Fertility and sterility 2020; 114(5):1049-57.
  34. Kor E, Mostafavi SR, Mazhin ZA, Dadkhah A, Kor A, Arvanagh SH, et al. Relationship between the severity of endometriosis symptoms (dyspareunia, dysmenorrhea and chronic pelvic pain) and the spread of the disease on ultrasound. BMC Research Notes 2020; 13:1-8.
  35. Barzegar -Bafrouei A, Javdani M. Importance and surgical methods of induction of endometriosis and osteoporosis following menopause in rats: an overview study. J Shahid Sadoughi Uni Med Sci 2022; 30( 5):4793-812.
  36. Missmer SA, Chavarro JE, Malspeis S, Bertone-Johnson ER, Hornstein MD, Spiegelman D, et al. A prospective study of dietary fat consumption and endometriosis risk. Human Reproduction 2010; 25(6):1528-35.
  37. Nelsen LM, Lenderking WR, Pokrzywinski R, Balantac Z, Black L, Pokras S, et al. Experience of symptoms and disease impact in patients with adenomyosis. The Patient-Patient-Centered Outcomes Research 2018; 11:319-28.
  38. Caruso M, Dell’Aversano Orabona G, Di Serafino M, Iacobellis F, Verde F, Grimaldi D, et al. Role of Ultrasound in the Assessment and Differential Diagnosis of Pelvic Pain in Pregnancy. Diagnostics 2022; 12(3):640.
  39. Tabibian N, Swehli E, Boyd A, Umbreen A, Tabibian JH. Abdominal adhesions: A practical review of an often overlooked entity. Annals of Medicine and Surgery 2017; 15:9-13.
  40. Hosokawa T, Tanami Y, Sato Y, Hosokawa M, Oguma E. The role of ultrasound to evaluate the disorders of sex development: a pictorial essay. Journal of Ultrasound 2022: 25:745-55.
  41. Khatri G, Sharma M, Kaul A, Thakral A, Gupta P, Tripathi N. A cross-sectional prospective assessment of the sonographic morphology of pelvic masses and its correlation with the histopathological diagnosis. European Journal of Molecular and Clinical Medicine 2022; 9(1):1142-51.
  42. Younis JS. Endometriosis-Associated Ovarian Cancer: What Are the Implications for Women with Intact Endometrioma Planning for a Future Pregnancy? A Reproductive Clinical Outlook. Biomolecules 2022; 12(11):1721.
مجله زنان، مامایی و نازایی ایران
دوره 26، شماره 4
تیر 1402
صفحه 46-58

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