Endometriosis is a chronic condition where lesions, consisting of tissue similar to the uterine lining, grow outside of the uterus. It’s estimated to impact 10 to 15 percent 生殖年龄的妇女。

Endometriosis can be divided into several different stages. These are based on factors like the number, location, and severity of endometriosis lesions.

In this article, we’ll take a closer look at the types of endometriosis lesions as well as endometriosis staging and whether endometriosis lesions can be removed.

The lining of your uterus is called the endometrium. During your月经周期，the endometrium thickens in order to prepare for the implantation of a fertilized embryo. If this doesn’t happen, the endometrium is shed during your时期.

子宫内膜异位病变是类似于子宫内膜的组织斑块。但是与子宫内膜不同，它们在子宫外的区域生长。

These lesions also thicken during your menstrual cycle and bleed during your period. However, because this tissue cannot leave your body, it can lead to the common symptoms of子宫内膜异位症, such aspain,swelling和消化问题。

子宫内膜异位病变的大小可能有所不同，并且通常以结节或囊肿的形式出现。它们大多为棕色，黑色或蓝色。但是，它们有时也可能是红色，白色或清晰的。

It’s also possible for endometriosis lesions to be associated with adhesions.Adhesionsare bands of scar tissue that can cause organs and tissues in the pelvis to stick together.

在哪里发现子宫内膜异位病变？

The most common areas for endometriosis lesions to be found are the:

  • 卵巢
  • 输卵管
  • outside surface of the uterus
  • ligaments surrounding the uterus

It’s also possible for endometriosis lesions to be found in other areas of the pelvis, such as the:

While endometriosis lesions mainly affect organs and tissues in the pelvis, they can, in rare instances, be detected in other areas. A few examples include the liver, lungs, or brain.

There are three different types of endometriosis lesions. These are generally categorized based on the area where they occur. It’s possible to have multiple types of endometriosis lesions at one time.

表面腹膜病变

表面腹膜病变are found on the peritoneum. This is the tissue that lines the pelvic cavity and organs. It’s the most common type of lesion, and accounts for about 80 percent 子宫内膜异位病变。

Endometriomas

Endometriomas are a type of cyst that most often appear on the ovaries, although they can, in some instances, appear on other tissues as well.

It’s estimated that between 17 and 44 percent of people with endometriosis will have an endometrioma.

With an endometrioma, the endometriosis tissue bleeds into the cyst, leading to accumulation of a brown fluid. For this reason, endometriomas are often referred to aschocolate cysts.

Deep infiltrating endometriosis (DIE)

Deep infiltrating endometriosis (DIE) refers to endometriosis lesions that penetrate 5 millimeters (mm) or more into the affected tissue. It’s estimated to affect about 20 percent of individuals with endometriosis.

DIE is the most aggressive form of endometriosis and is often associated with severe symptoms. The main areas where DIE can occur include the:

  • ligaments surrounding the uterus
  • tissue between the uterus and rectum (pouch of Douglas)
  • area of the vagina known as the posterior fornix
  • tissue separating the vagina and rectum (rectovaginal septum)
  • urinary tract, including the bladder and ureters
  • intestines

Diagnostic laparoscopyis the only sure way to know if you have endometriosis. Laparoscopy uses an instrument called a laparoscope to examine the organs and tissues of your pelvis. It’s a minimally invasive surgery that only uses small incisions.

This procedure often involves the collection of a活检样本from an endometriosis lesion. The biopsy sample is then carefully examined in a laboratory.

Other imaging techniques, such asultrasound或者magnetic resonance imaging (MRI), may also be used during diagnosis and for planning treatment.

医生可以使用从诊断性腹腔镜检查中获得的信息进行子宫内膜异位症。

美国生殖医学学会（ASRM）分期系统

The American Society for Reproductive Medicine (ASRM) criteria is most often used to stage endometriosis. This uses a scoring system to evaluate:

  • the presence of endometriosis lesions affecting the peritoneum, ovaries, and fallopian tubes
  • how deeply endometriosis lesions penetrate the surrounding tissue
  • 是否存在粘连和他们一个多么密集re

With the ASRM criteria, higher scores are associated with more extensive endometriosis. There are four different stages:

  • Stage I (minimal).Individuals with stage I endometriosis typically have a few superficial endometriosis lesions.
  • Stage II (mild).In stage II endometriosis, more lesions are observed, and they typically penetrate deeper into the affected tissue.
  • Stage III (moderate).患有III期子宫内膜异位症的人经常患有：
    • a large number of deep endometriosis lesions
    • 一个或两个卵巢上的子宫内膜瘤
    • 一些粘连
  • Stage IV (severe).Those with stage IV endometriosis typically have:
    • a large number of deep endometriosis lesions
    • large endometriomas on one or both ovaries
    • many dense adhesions

The stage of endometriosis doesn’t always correlate with symptom severity. It just reflects how extensive endometriosis is. For example, it’s possible to have stage II endometriosis and still experience severe pain and swelling.

The Enzian classification

ASRM系统的缺点之一是，它不解释存在深层子宫内膜异位症（DIE）的存在，这会影响ASRM系统中包含的组织以外的其他组织。

The Enzian classification system was developed to describe the extent of DIE in a person with endometriosis. It takes the following factors into account:

  • Location.有3个单独的隔间，每个隔间都通过字母分类。
    • Compartment A includes the vagina and the pelvic space between the vagina and the rectum.
    • Compartment B includes the pelvic wall and the ligaments of the pelvis.
    • Compartment C includes the colon and rectum.
  • 等级。水平标准是子宫内膜异位病变渗透到受影响的组织的多远。有3个级别：
    • 1级小于1厘米。
    • 2级为1至3厘米。
    • Level 3 is greater than 3 centimeters.
  • Other affected organs.This accounts for the involvement of additional organs, including the:
    • bladder
    • ureters
    • intestines
    • 骨盆外的器官

A 2013 study 评估了194例子宫内膜异位症患者的enzian系统。发现了更严重的恩兹分类与更严重的ASRM评分之间的相关性。

Also, symptoms like pain andsevere menstrual cramps与更严重的enzian分类有关。

The Endometriosis Fertility Index (EPI)

Another drawback of the ASRM system is that it does not reflect how endometriosis can affect your fertility. This is often an important concern for people with endometriosis who want toget pregnant.

子宫内膜异位症生育指数（EPI）的开发是为了帮助描述怀孕的可能性。它使用多种因素，包括：

  • the estimated function of the ovaries, fallopian tubes, and fimbria
  • personal information like age, number of years you’ve experiencedinfertility, and history of prior pregnancies
  • the score from the ASRM system

A 2018年研究 评估了EPI在预测没有的能力时体外受精（IVF）.

它发现，无论个体是否患有子宫内膜异位症，EPI都比ASRM系统更好地预测受孕的可能性。

As we mentioned earlier, a surgical diagnosis using laparoscopy is very important in determining if you have endometriosis. Once a diagnosis of endometriosis has been confirmed, it’s also possible for endometriosis lesions to be removed using surgery.

Undergoingsurgeryto remove endometriosis lesions is typically recommended if more conservative treatments haven’t provided relief or you’re experiencing infertility due to endometriosis.

子宫内膜异位手术经常进行使用腹腔镜. During the procedure, the surgeon works to locate endometriosis lesions. They’ll then destroy or remove them. This type of surgery preserves your fertility.

有两种不同类型的腹腔镜手术用于子宫内膜异位症 - 切除和消融。

During excision, the surgeon carefully cuts away the endometriosis lesions. During ablation, endometriosis lesions are destroyed using things like heat, freezing, or a laser beam. Excision is generally 更加有效 at relieving symptoms.

子宫切除术can also be used to remove endometriosis lesions, particularly those affecting the outside of the uterus and surrounding tissues like the ovaries.This surgeryinvolves the removal of the uterus and can also include removal of the ovaries, fallopian tubes, or both. This is typically a last resort option, as you’ll no longer be able to become pregnant afterward.

A recurrence of endometriosis lesions is fairly common after surgery. The recurrence rate after surgery has been estimated to be between 6 and 67 percent , although the rate can depend on several factors like the type of surgery and endometriosis lesions.

一些evidenceshows that excision has lower recurrence rates in women with endometriosis that’s a lower ASRM stage.

Overall, deciding to have surgery for endometriosis is a big decision. It’s important to discuss all the risks and benefits of surgery with your doctor before deciding to have a procedure.

子宫内膜异位症的其他治疗方法

如果您不是您的手术，那么还有其他子宫内膜异位症treatmentsthat may help, such as:

  • Medications.Several different types of medications may help curb the symptoms of endometriosis. These include:
    • gonadotropin-releasing hormone (GnRH) agonists, which halt the production of hormones important for your menstrual cycle, leading to a temporary menopause
    • 非处方药（OTC）药物ibuprofen（Advil，Motrin），naproxen(Aleve), andacetaminophen(Tylenol), which may be helpful for mild pain or swelling due to endometriosis
  • 补充和替代医学（CAM）。一些people report that CAM therapies likeherbs and supplements,acupuncture， 或者massage therapy帮助缓解症状。
  • Lifestyle changes.实施生活方式的改变也可能有助于缓解子宫内膜异位症的症状。这可以包括：
    • seeking support from friends and family or through a support group or mental health professional

You may need to use several types of treatment to help with endometriosis. Also, you may need to try out different combinations of treatments before you find what works best for you.

Endometriosis causes lesions that consist of tissue like the lining of your uterus to appear in places where they do not belong. This can lead to symptoms like pain, swelling, and digestive problems. Endometriosis can also affect fertility.

子宫内膜异位病变最常见的区域是子宫和卵巢周围或周围。但是，它们也可以影响阴道，肠道和尿路。

子宫内膜异位症是根据子宫内膜异位病变的数量，位置和严重程度分期的。但是，子宫内膜异位症的阶段并不总是反映出症状的严重性。

在某些情况下，可能建议进行手术以切除子宫内膜异位症病变。如果无法选择手术，药物，CAM疗法和生活方式的改变可能有助于减轻子宫内膜异位症的症状。