子宫内膜异位症与子宫腺肌病的发病机理。,Journal of Clinical Medicine

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子宫内膜异位症与子宫腺肌病的发病机理。
Journal of Clinical Medicine ( IF 3.0 ) Pub Date : 2020-02-10 , DOI: 10.3390/jcm9020485
Sun-Wei Guo _{1,

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Affiliation

子宫腺肌病以前被称为内部子宫内膜异位症，而深部子宫内膜异位症现在被称为外子宫腺肌病。因此，从发病机理或病理生理学的角度来看，子宫腺肌症是否仅是子宫内膜异位症存在一个问题。在此手稿中，使用PubMed对所有与子宫腺肌病和子宫内膜异位症相关的英语出版物进行了全面的综述，包括从成立到2019年6月20日的所有英文出版物。此外，两种流行的理论，即基于组织损伤的内陷对腺肌病发病机理的研究和修复（TIAR）假设和化生进行了简要概述，然后进行了严格审查。两种理论都有明显的局限性，即难以证伪，难以解释现有数据以及无法做出有用的预测。基于目前对伤口愈合的理解，提出了一种新的假设，称为子宫内膜-子宫肌层界面破坏（EMID），以解释由医源性EMI引起的子宫腺肌症。EMID假说不仅突出了伤口部位的显着特征，即缺氧，而且还整合了上皮间充质转化，骨髓来源干细胞的募集，以及增强了因以下原因而分散和移位的子宫内膜细胞的存活和传播能力：医源性程序。更重要的是，EMID假设预测，如果进行某些围手术期干预，可以降低子宫腺肌症的风险。因此，从致病的角度来看，子宫腺肌病不仅仅是子宫内膜异位症，因此，

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The Pathogenesis of Adenomyosis vis-à-vis Endometriosis.

Adenomyosis is used to be called endometriosis interna, and deep endometriosis is now called adenomyosis externa. Thus, there is a question as to whether adenomyosis is simply endometriosis of the uterus, either from the perspective of pathogenesis or pathophysiology. In this manuscript, a comprehensive review was performed with a literature search using PubMed for all publications in English, related to adenomyosis and endometriosis, from inception to June 20, 2019. In addition, two prevailing theories, i.e., invagination-based on tissue injury and repair (TIAR) hypothesis-and metaplasia, on adenomyosis pathogenesis, are briefly overviewed and then critically scrutinized. Both theories have apparent limitations, i.e., difficulty in falsification, explaining existing data, and making useful predictions. Based on the current understanding of wound healing, a new hypothesis, called endometrial-myometrial interface disruption (EMID), is proposed to account for adenomyosis resulting from iatrogenic trauma to EMI. The EMID hypothesis not only highlights the more salient feature, i.e., hypoxia, at the wounding site, but also incorporates epithelial mesenchymal transition, recruitment of bone-marrow-derived stem cells, and enhanced survival and dissemination of endometrial cells dispersed and displaced due to iatrogenic procedures. More importantly, the EMID hypothesis predicts that the risk of adenomyosis can be reduced if certain perioperative interventions are performed. Consequently, from a pathogenic standpoint, adenomyosis is not simply endometriosis of the uterus, and, as such, may call for interventional procedures that are somewhat different from those for endometriosis to achieve the best results.

更新日期：2020-02-10

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