[Analysis of characteristics and influence factors of diagnostic delay of endometriosis].

Objective: To access the influence factors of diagnostic delay of endometriosis. Methods: We designed a questionnaire of diagnostic delay of endometriosis. From February 2014 to February 2016, 400 patients who had dysmenorrhea and diagnosed with endometriosis by surgery in Peking University Third Hospital were surveyed retrospectively. Time and risk factors of diagnostic delay were analyzed. Results: The diagnostic delay of 400 patients was 13.0 years (0.2-43.0 years), 78.5%(314/400) patients thought pain was a normal phenomenon and didn't see the doctor. Patients who suffered dysmenorrhea at menarche experienced longer diagnostic delay than those who had dysmenorrhea after menarche (18.0 vs 4.5 years; Z=191.800, P<0.01) . Patients who suffered aggravating dysmenorrhea experienced shorter delay time than those who suffered stable or relieving dysmenorrhea (11.0 vs 12.5 vs 18.0 years; Z=8.270, P<0.05) , with the difference statistically significant, single factor analysis shows. Severe dysmenorrhea, deep infiltration endometriosis (DIE) , family history of dysmenorrhea or endometriosis, previous surgical history of endometriosis, high stage, with infertility, adenomyoma or other symptoms, could help to shorten diagnostic delay with no significant difference (P>0.05) . By multiple logistic regression analysis, the results shown that whether have dysmenorrhea at menarche and clinical diagnosis time were the independent factors affecting delayed diagnosis (P<0.01) . Conclusions: Diagnostic delay of endometriosis is common and the mean delay time is 13.0 years mainly due to the unawareness of dysmenorrhea. Dysmenorrhea at menarche, clinical diagnosis time and dysmenorrhea intensity are the factors affecting time of diagnostic delay.目的：探讨子宫内膜异位症（内异症）诊断延迟的原因及影响因素。 方法：设计内异症诊断延迟调查表，对400例于2014年2月至2016年2月在北京大学第三医院住院，有痛经症状并经手术后病理检查确诊为内异症的患者进行回顾性调查研究，分析诊断延迟的原因及影响因素。 结果： 400例内异症患者的诊断延迟时间为13.0年（0.2~43.0年）。其中，78.5%（314/400）的患者认为痛经是正常现象对痛经症状重视不足而未就诊，12.0%（48/400）的患者自行服用中药或在出现痛经症状前就已诊断为内异症，仅9.5%（38/400）的患者出现痛经症状后立即就诊。单因素分析显示，内异症的诊断延迟时间，初潮即出现痛经的患者明显长于初潮后出现痛经者（中位数分别为18.0、4.5年；Z= 191.800，P<0.01），痛经加重的患者明显短于痛经不变和缓解者（中位数分别为11.0、12.5和18.0年；Z=8.270，P<0.05），内异症的临床诊断时间≤12年的患者明显短于临床诊断时间>12年者（中位数分别为6.0、20.0年；Z=-17.079，P<0.01）；而不同痛经程度、是否合并深部浸润型内异症（DIE）、有无痛经或内异症家族史、既往有无内异症手术史、不同内异症期别、是否合并不孕、有无伴随症状之间分别比较，差异均无统计学意义（P>0.05）。多因素分析显示，初潮即出现痛经、内异症的临床诊断时间是影响内异症诊断延迟的独立因素（P<0.01）。 结论：内异症存在诊断延迟且长达13.0年，主要与患者对痛经症状重视不足有关。初潮即出现痛经、痛经症状变化程度、内异症的临床诊断时间是诊断延迟的影响因素。.