The Clinical Research Of Peritoneal Endometriosis Diagnosis And Treatment During Laparoscopy With Narrow-band Imaging

Objective:To evalute the practical value of the diagnosis and treatment in peritoneal endometriosis during laparoscopy with narrow-band imaging(NBI). The comparative study is using ordinary white light(WL) and NBI technology respectively in laparoscopic diagnosis the peritoneal endometriosis. To discuss whether the early pathological changes can be found during laparoscopy with NBI,which is not easily found with the WL.Can NBI technology improve the sensitivity and negative predictive value of laparoscopic diagnosis, reduce the missed diagnosis rate?To provide a basis that NBI can be as a assisted diagnosis for peritoneal endometriosis;Through the analysis of different peritoneal endometriosis of microvascular morphology characteristics and the types of microvascular characteristics.To conclude study different types of endometriosis lesions under NBI features such as microvascular morphology characteristics and the types of microvascular; To conclude simple characteristics of different types of peritoneal endometriosis under NBI, to play a optical auxiliary guide role in different peritoneal endometriosis diagnosis during laparoscopy with NBI; By studying whether the NBI can see the boundary of the lesion more clearly, it can help specify the size and scope of the lesions, and guide the treatment of intraoperative cut net lesions thoroughly, and provide reliable basis with reducing postoperative recurrence rate and improving the pregnancy rate; Pathological diagnosis as the gold standard.To compare the clinical value of diagnosis and treatment of endometriosis with ordinary WL and NBI during laparoscopy.Methods:This prospective, non-randomized comparative study was performed at the dalian maternity hospital affiliated to dalian medical university from July 2014 to February 2015,51 women undergoing laparoscopic evaluation for suspected endometriosis and/or infertility or dysmenorrhea were recruited,whichsurgical treatment of both the laparoscopic diagnosis and pathological histology diagnosis as the gold standard. In hd-laparoscopic surgery, the first thing to do is the comprehensive exploration abdominopelvic cavity under WL, observing pelvic peritoneum, and recording a diagnosis of peritoneal type in different disease lesion under WL,then converting into observed pelvic peritoneum under NBI. Record the WL + NBI different disease in the diagnosis of peritoneal type lesions and in two modes of focal line photo, cut off different disease lesion below the peritoneum and suspicious lesions within the organization completely, histologic examination diagnosis, compare the WL and WL + NBI two modes of peritoneal type in different disease diagnosis accuracy and sensitivity. Analyze the peritoneal lesions images taken,analysis of peritoneal type in different lesions of the microvascular morphology characteristics and the types of microvascular disease characteristics,conclude morphologic characteristics of different types of peritoneal endometriosis.Postoperative follow-up closely, record relapse.Results:1、Peritoneal endometriosis in different disease incidence38 patients with peritoneal endometriosis, aged 22 to 47 years(35.16.6 years), take the 72 peritoneal endometriosis specimens, at the same time surface normal peritoneum laparoscopic random biopsies 38 specimens of 110 copies finally. 38 cases of peritoneal endometriosis merger exists in different diseases, combined exist in the ovarian endometriosis in highest(71%)among different disease.Different disease proportion within the peritoneal disease, 32 cases of ovarian type found27 cases of peritoneal endometriosis in different patients, accounting for 84.3% of the patients with ovarian endometriosis; 13 patients with pure hysteromyoma,which compandaccompanying peritoneal endometriosis is 8 cases, accounting for 61.5% of the patients with uterine fibroids.2、Peritoneal morphological characteristics of the Laparoscopic diagnosis with NBI Peritoneal endometriosis refers to endometriosis occurred within the basin of abdominal peritoneal, during laparoscopy with standard white light: you can see red lesions(early lesions),blue lesions(typical lesions) and white lesions(old lesions) or mixed lesions [1]. Still included rare types such as brown lesions, bullate lesions, transparent lesions [2]. And laparoscopic diagnosis with NBI in peritoneal endometriosis its surrounding green vascular network,such as radial or interrupt type or disorder hyperplasia and normal peritoneum forms a sharp contrast,which is easier identify lesions than with the WL, different types of peritoneal disease lesions with laparoscopic diagnosis under NBI were characterized by as follows:Red lesions: Scattered bright black particles or patches.Blue lesions: white irregular radial or branching fiber contracture nodules, see green plaque lesions under the center, around the visible clear green vascular network, and clear lesions boundaries.White lesions: white irregular fibre nodules or keloid scar sample(keloid), scattered around in the dark green grain lesion, shows clearly green vascular net radiated gathered around,makes lesions border more clear.Brown lesions: visible white scar adhesion obviously, which are gathered and green vascular network in contrast, are still visible green wide particle lesion.Bullate lesions: white peritoneal bullate lesions on the surface of the organization, the surrounding green visible vascular network.Transparent lesions: lesions show pink, contrasts with radial around green vascular network.3. Under the WL and WL +NBI diagnostic peritoneal endometriosis compared with pathological results The consistency of identifying different lesions and pathological results under the white light is 61% and the good consistency under the WL + NBI is 80%. normal examination in abdominal peritoneal with laparoscopic under WL,while under the NBI technology found 13 lesions, including 12 lesions(92.3%)pathologic positive.Laparoscopic diagnosis under NBI can found more lesions than under the normal WL, mainly red lesions and white lesions, whileblue lesions 、brown lesions and mixed lesions had no difference. But blue lesions and white lesions boundary were more clearly under NBI, can guide the intraoperative cut lesions completely.4. Laparoscopic diagnosis under WL +NBI and under the WL of accuracy, sensitivity,specific comparison Diagnostic peritoneal endometriosis under the WL of accuracy, sensitivity, the missed diagnosis, negative predictive value were 80.9%, 77.1%, 22.9%, 68.6% respectively, while under the WL + NBI were 90.9%, 94.28%, 5.7%, 89.47%, P < 0.05 was statistically significant.Diagnostic peritoneal endometriosis under the WL of specific degrees, the misdiagnosis rate,positive predictive value were 87.5%, 12.5%, 91.5% respectively, under the WL + NBI were85%, 15%, 91.67% respectively, P > 0.05,was no statistical significance. The WL and WL +NBI Youden index of was 64.6%, 79.3% respectively.Conclusion:Peritoneal endometriosis merger exists in different diseases; Peritoneal endometriosis in laparoscopic under NBI and WL two modes can be characterized by different tissue morphological characteristics;Laparoscopic diagnosis under WL +NBI and pathological d iagnosis results have good consistency, which can identify more lesions and lesions bord er shows more clearly under NBI than ordinary WL, guide intraoperative cut lesions mo re entirely; Laparoscopic diagnosis under WL +NBI has a higher degree of accuracy an d sensitivity than under WL, we can identify more lesions, reduce missed diagnosis,and improve the negative predictive value.