Endometriosis is a disease caused by the appearance, growth, infiltration and recurrent bleeding of endometrial tissue in other parts of the uterine cavity than the covered endometrium, and is a common benign gynecological disease, but has the ability to metastasize and grow distantly like malignant tumors. It mostly occurs in women of childbearing age, clinically manifested as dysmenorrhea, infertility, menstrual irregularities, pelvic masses, etc. The incidence accounts for 1% to 7% of the general population, 10% to 15% of women of childbearing age, 2% to 4% of postmenopausal women, 35% to 60% of infertile women, and the incidence has a significant upward trend, is highly infiltrative, can cause extensive and severe adhesions, and is characterized by a high recurrence rate, which seriously affects the The incidence of endometriosis is very infiltrative and can cause extensive and serious adhesions, and is characterized by high recurrence rate, which seriously affects the quality of life of women of childbearing age, and is imaginatively called “sandstorm”, “benign cancer” and “modern disease” of women’s pelvis. The pathogenesis of endometriosis was first described by Von Rokitansky in 1860, but the pathogenesis of endometriosis is still unclear. The World Endometriosis Society (WES), founded in 1998, suggests that endometriosis is a genetic, immune, hormone-dependent, inflammatory, hemorrhagic, and organ-dependent disease. At the end of last century, Lang Jinghe proposed the “endometriosis in situ determinism”, which pointed out that the abnormal characteristics of endometriosis in situ endometrial cells were the fundamental determinant of its pathogenesis; and at the beginning of this century, Xu Congjian further proposed that endometriosis was a “stem cell” through the study that male bone marrow stem cells could differentiate into endometrial cells in vivo. The research on the differentiation of bone marrow stem cells into endometrial cells in male rats at the beginning of this century further suggested that endometriosis is a “stem cell disease”. Endometriosis is classified as peritoneal endometriosis (PEM), which refers to various endometriotic lesions, such as red lesions, blue lesions and white lesions, occurring in the peritoneum of the pelvic abdomen. Ovarian endometriosis (OEM): The most common type of endometriosis is the formation of cysts (endometriotic cysts) in the ovary. 80% of the cases involve unilateral and 50% involve bilateral ovaries and are classified into type I and type II according to the size of the cysts and the degree of infiltration of the ectopic foci. Deeply infiltrating endometriosis (DIE): is a lesion infiltrating to a depth of ≥5 mm, commonly in the uterosacral ligament, the rectal fossa, the vaginal vault, and the genital rectal septum. Other sites of endometriosis (OtEM): including digestive, urinary, respiratory and scar endometriosis. 3. Diagnosis of endometriosis 1. Non-surgical diagnostic methods: ① Combined diagnosis of symptoms: pain symptoms, infertility, pelvic pain nodes, ultrasonography, serum CA125, the positive predictive value of the above three combined diagnoses is 92%-100%; ② Some tests of serology: serum vascular endothelial growth factor (VEGF) 142 ng/L is the diagnostic cut-off point for EM when its diagnostic The sensitivity, specificity, positive predictive value and negative predictive value were 0.930, 0.930, 0.968 and 0.833, respectively, while VEGF also provided a more accurate assessment of the staging and efficacy of endoheteropathy; ③ Some tests of endothelium: the sensitivity and specificity of endothelial neuronal marker PGP 9.5 for the diagnosis of Ems were 100% (15/20 cases). 2. Surgical diagnostic methods: ① Laparoscopy is currently the “gold standard” for the diagnosis of endometriosis. It allows direct observation of the lesion, r-AFS staging, and biopsy (40-70% pathologically confirmed). However, a negative laparoscopic result does not indicate the absence of a lesion, and a positive result does not indicate the definitive presence of a lesion. Both the surgical equipment and the experience of the operator are important. ② Narrow band imaging (NBI) can improve the diagnosis of atypical lesions by laparoscopy In recent years, NBI has been used for the diagnosis of tumors. In the NBI system, the broadband light waves in the red, green and blue spectrum are filtered through a filter, leaving only the blue and green narrowband light waves of 415nm and 540nm wavelengths, which can be absorbed by the blood thus increasing the contrast and clarity of the mucosa and submucosal vessels, improving the accuracy of diagnosis and reducing the false negative rate of ordinary white light laparoscopy, with a sensitivity of 100% and specificity of 75 % for PEM. NBI can detect early peritoneal lesions, clarify the size of lesions, and guide the scope of surgical resection. Staging of endometriosis The current staging method is the “modified endometriosis staging method” proposed by the American Fertility Society (AFS), revised in 1985. The specific staging should be done after surgery to score the site, size, number, depth and degree of adhesions of the lesion. The staging of endometriosis should be emphasized in medical work-up so that the severity of the disease can be correctly assessed and provide a basis for selecting further treatment options and evaluating the efficacy. V. Treatment of endometriosis should, firstly, clarify that the objectives of treatment are to reduce and eliminate lesions, relieve and relieve pain, improve and promote fertility, and reduce and avoid recurrence. Second, an individualized treatment plan should be implemented according to the patient’s age, condition and fertility requirements. Surgery is the basic and preferred treatment for endometriosis and includes 3 types of surgery: conservative, semi-radical and radical. 1. Surgical treatment laparoscopic surgery has become the preferred surgical procedure for endometriosis because of its minimally invasive (less tissue damage, clear vision, less postoperative adhesion formation, low complication rate, fast recovery, etc.) characteristics. Preoperative preparation: The most important thing before surgery is to accurately assess the severity of the disease and to communicate with the patient or family to obtain their understanding and informed consent; to assess the risks of surgery, the possibility of intraoperative loss of adjacent organs and the possibility of intermediate open abdomen; for those with deep parametrial infiltration, preoperative structural and functional assessment of the urinary system should be done; for those with vaginal-rectal septum DIE, adequate bowel preparation should be done before surgery For those with DIE, adequate bowel preparation should be done before surgery. The main points of surgery for different types of endometriosis: Peritoneal endometriosis The lesion should be removed or destroyed as much as possible to achieve the purpose of reducing the lesion, separating the adhesions and restoring the normal anatomy of the pelvis. Ovarian endometriosis accounts for 35% of benign tumors. Cystectomy is the preferred surgical procedure for ovarian endometriosis and is more effective than cyst puncture aspiration electrocautery. During surgery, the adhesions should be fully separated, the ovary should be freed, the anatomy should be restored, the correct level should be found, the cyst wall should be torn out, the ovarian tissue at the ovarian gate should be protected, electrocoagulation should be reduced, and attention should be paid to the ureteral course to avoid injury. How to completely remove the lesion while preserving ovarian ovulation and endocrine function as much as possible is a big challenge for gynecologists at present. For ovarian trauma, suture hemostasis is more effective than electrocoagulation hemostasis to protect ovarian function, which requires higher microscopic suture technique of the surgical operator; bipolar electrocoagulation is better than monopolar electrocoagulation; bipolar spot coagulation is better than piece coagulation hemostasis. Therefore, it is very important to train in the operation of laparoscopy and it is very important for the operator to be familiar with the performance of laparoscopic instruments. Deep infiltrative endometriosis Surgical treatment is preferred, but because DIE often involves the intestinal canal and ureter, surgery is risky and difficult, requiring the operator to have skilled surgical skills and to be familiar with the local anatomy. Its lesions are mainly fibrous connective tissue with abundant nerves, so the pain is long and pronounced and insensitive to drugs. Intraoperative removal of as many lesions as possible is crucial for postoperative symptom relief. If the lesion invades the ureter, a ureteral catheter can be placed preoperatively as an intraoperative indication. In the extrinsic type, only the adhesions and nodules on the ureteral surface can be removed, while in the intrinsic type, the ureteral segment at the lesion should be removed and anastomosed intraoperatively. If the lesion invades the intestinal canal, a comprehensive analysis should be made depending on the size of the lesion, the depth of invasion, the resulting symptoms and postoperative complications, and the pros and cons should be weighed to decide whether to perform a partial resection of the intestinal segment. Scar endothelia Medication is mostly insensitive and surgical resection is the mainstay. In general, the ideal surgery is one that can relieve symptoms, preserve reproductive function, and is minimally invasive, which can effectively improve the quality of life of patients. 2.Drug therapy drug therapy aims to inhibit ovarian function, stop the progression of endoheterosis, reduce the activity of endoheterotic lesions as well as reduce the formation of adhesions. The use of drugs should take into account the side effects of drugs, the patient’s wishes and financial ability, and long-term “experimental drug therapy” is not recommended. Oral contraceptives are safe, well-tolerated, inexpensive, and can reduce pain, suppress ovulation, shrink the endometrium, reduce menstrual flow, and decrease prostaglandin production. Especially suitable for adolescent endometriosis. GnRHa can effectively inhibit ovarian function, block the development of endometriosis, reduce its activity and adhesion formation, and can be used as preoperative and postoperative adjuvant therapy. GnRHa is effective in reducing the level of pain-causing factors, with a symptom relief rate of 80-90%, and for dysmenorrhea, its addition after surgery can significantly reduce recurrence rates. However, GnRHa can only reduce or counteract blood E levels, but has no effect on locally produced E in the lesion, and has the disadvantages of high cost, poor compliance, and high recurrence rate after discontinuation of the drug. Its use in adolescence is controversial. Both high potency progestins and danazol are currently used less frequently due to their side effects. (iii) Prospects for drug treatment: Changing the route of administration Such as levonorgestrel intrauterine release system (Mannorrhea), a locally applied progestin, should be excluded from endometrial and cervical lesions before use, and irregular vaginal bleeding or amenorrhea may occur after episiotomy. Development of new drugs Such as aromatase inhibitors, GnRH antagonists, estrogen and progesterone receptor modifiers, anti-angiogenic agents, anti-adhesive agents, and herbal medicines. The incidence of malignancy in endometriosis is about 1%, mainly in the ovaries, and less in other parts of the body. The following conditions should be alerted to malignant change: ① OEM cysts are too large, with a diameter of more than 10 cm, or have a tendency to increase significantly; ② recurrence after menopause, change in pain rhythm, progression of dysmenorrhea or persistent abdominal pain; ③ CA125 > 200 KIU/L; ④ imaging examination shows: substantial within the cyst, or raised papillae, or rich blood flow in the lesion, or cystic fluid becomes thin; ⑤ cysts do not shrink or persist. but the dysmenorrhea was relieved or improved. In conclusion, endometriosis has always been a hot area of research for gynecologists, and it is the direction of our future work to further clarify the pathogenesis, make effective diagnosis, and improve the clinical efficacy.