Spontaneous cutaneous endometriosis in Mons Pubis: review of literature

Cutaneous endometriosis is not a very often seen condition and is broadly classified as primary (spontaneous) and secondary. While perineal endometriosis arising in a previous scar has been reported, spontaneous cutaneous endometriosis in perineum is extremely rare and only three cases occurring in mons pubis have been reported in literature. We report a case of 34-year-old lady presented with a swelling in pubic region and associated dull aching pain of 1-year duration with no history of cyclical variation of symptoms. Investigations finally concluded a diagnosis of endometriosis and a Complete excision with clear margins. Clinicians should be aware that a spontaneous endometriosis in the perineum can occur and can have atypical presentation with no increase in size or pain during menstruation.     

Mini-abdominoplasty combined with mesh used for abdominal wall endometriosis

Background  Wide excision is considered the treatment of endometriosis. It is difficult to surgeon for reconstruction of a large full-thickness defect through the abdominal-wall. We introduce a method of mini-abdominoplasty combined with mesh that can be used for reconstruction of a large full-thickness defect through the abdominal-wall after wide excision of abdominal wall endometriosis.

Methods  This retrospective study includes a series of patients who underwent wide excision of abdominal wall endometriosis and reconstruction of a large full-thickness defect through the abdominal-wall over a 5-year period. Information obtained from chart reviews includes age, size of lesion and defect, complications and revisions. 

Results  The method was used for 8 patients including 2 patients with recurrence. The mean size of the masses was (3.5±2.0) cm. The mean size of the fascia defects was 7.1 cm × 8.6 cm. The mean length of follow-up was (24±12) months. There was no recurrence, no hernia, and no other complications. The technique generated only a horizontal scar. The scar and contour of the lower abdomen provided a more pleasant appearance than the traditional procedure.

Conclusions  Mini-abdominoplasty combined with mesh is a useful and acceptable reconstruction method for large full-thickness defects through the abdominal wall after endometriosis resection. It is feasible for wide excision with 1 cm normal tissues around the margin. It provides an aesthetically pleasing result.

     

剖宫产术后腹壁切口子宫内膜异位症临床观察及治疗

目的:探讨剖宫产后腹壁切口处发生子宫内膜异位症的临床特点、治疗方法及防治措施.方法:对我院2005年6月至2010年3月收治的21例剖宫产术后于腹壁切口处发生子宫内膜异位症的患者临床资料进行回顾性分析.结果:21例患者腹壁肿块均经手术切除,术中发现内膜异位结节多见于皮下,占80.9%,切除病灶肉眼观为紫蓝色、深褐色结节...     

ABDOMINAL SCAR ENDOMETRIOSIS： REPORT OF 28 CASES

Twenty-eight cases of abdominal scar endometriosis from Janurary,1989 to December,1993 are reported.Of these patients,twenty-four underwent term cesarean section,and four underwent a midtrimester abortion by abdominal hysterotomy.The majority of patients manifested symptoms 1 year after the operation.The most common was a painful mass of scar tissue that became swollen and tender during menstruation.The pathogenesis,diagnosis and treatment are discussed.In correlation with the pathological findings,the effects of drug therapy are evaluated.It was found that surgical excision is the best method of treatment.     

腹壁子宫内膜异位症的临床分析

目的：探讨腹壁子宫内膜异位症的发病特点及手术治疗效果,以提高诊治水平。方法：分析27例经手术病理证实为腹壁子宫内膜异位症患者的临床资料,包括发病年龄、既往手术病史、临床症状与月经的关系、发病时间、病灶数量及手术效果。结果：27例患者发病年龄为24～43岁,平均32．22岁,中位年龄32岁,以30～39岁年龄段发病人数最多（18／27,66．67％）,与其他年龄段比较差异有统计学意义（P〈0．01）。27例既往均有剖宫产史,且均以切口区疼痛性包块就诊,其中切口区单发病灶者24例（88．89％）,2处病灶3例（11．11％）。临床症状及包块大小变化与月经的关系密切者21例（77．78％）,关系不明显6例（22．22％）,两者差异有统计学意义（x2=16．67,P〈0．01）。腹壁子宫内膜异位症发病时间为术后3个月～7年不等,以术后2年发病率最高（55．56％）。结论：腹壁子宫内膜异位症具有典型的临床表现,术前诊断不难,手术切除近期疗效满意,彻底切除病灶、适度切除周围正常组织是预防其复发的关键。     

Umbilical endometriosis mimicking as papilloma to general surgeons: A case report

Introduction

Cutaneous or umbilical endometriosis is a rare entity that is often overlooked because of chronic abdominal pain. We present a case of umbilical hernia that presented to the general surgeons due to chronic abdominal pain and nodule in the umbilicus, which was clinically diagnosed as umbilical papilloma.

Case presentation

A 48-year old multiparous Caucasian woman presented with painful nodule in the umbilicus for two and half years. The nodule was excised and the histopathological diagnosis was umbilicus endometriosis.

Conclusion

Umbilical endometriosis is a very rare disease but should be considered as a differential diagnosis in women presenting with umbilical swelling.     

手术治疗联合药物治疗腹壁子宫内膜异位症的临床研究

目的:探讨手术治疗联合药物治疗腹壁子宫内膜异位症的临床疗效。方法:分析剖宫产后腹壁子宫内膜异位症患者40例临床资料,根据手术治疗方式不同分为观察组(手术治疗联合药物治疗组)20例和对照组(手术治疗组)20例。结果:观察组腹壁子宫内膜异位症患者临床治疗总有效率明显高于对照组,两组腹壁子宫内膜异位症患者治疗后CA125均明显优于治疗前,差异均有统计学意义(P<0.05)。结论:手术治疗联合药物治疗腹壁子宫内膜异位症临床疗效明显,效果良好,值得临床推广应用。     

会阴子宫内膜异位症30例临床分析

目的探讨会阴子宫内膜异位症的临床诊断及治疗。方法对30例会阴子宫内膜异位症（简称内异症）病例进行回顾性分析,术后随诊0．5—13年。结果会阴内异症占院内同期内异症的0．32％,阴道分娩发生会阴内异症为0．0065％,发病潜伏期为4个月至13年。会阴内异症均表现为会阴伤口的周期性、痛性结节,CA125值无明显升高,病灶完整切除者可达到治愈。5例（16．7％）患者合并盆腔内异症。结论根据典型的病史和体格检查可做出正确的诊断,会阴内异症可合并盆腔内异症存在,手术切除是主要的治疗方法,未累及肛门括约肌的患者由于手术可完整切除,复发率低于累及肛门括约肌的病例,是否累及肛门括约肌的术前评价至关重要。     

46例腹壁子宫内膜异位症临床分析

目的：探讨腹壁子宫内膜异位症（AWE）的临床特点、治疗方法和预防。方法：回顾性分析1993至2007年两院收治的46例腹壁子宫内膜异位症病例。结果：腹壁子宫内膜异位症发生于剖宫产之后,表现为切口部位出现疼痛肿块并随月经周期变化,有较为典型的病史及临床表现,术前均诊断正确。手术彻底切除,随访2～5年无复发。结论：AWE治疗首选手术,范围应达病灶外1cm。     

A case report of neck, chest and upper limb cutaneous metastasis from synchronous colorectal cancer

Cutaneous metastasis from colorectal carcinoma is uncommon, occurring in less than 4% of the whole patients. The most frequently involved are incision scar or abdominal skin, while cutaneous metastasis to neck and chest is very rare. We hereby report a case of synchronous, postoperative cutaneous metastasis from colorectal carcinoma to neck, upper limb and chest skin, which were confirmed by biopsy.     

腹壁会阴切口子宫内膜异位症30例临床分析

目的探讨腹壁子宫内膜异位症(内异症)的发病机制、诊断和治疗。方法回顾性分析我院1987年-2003年收治的30例腹壁会阴切口内异症的临床特点、治疗方法。结果30例患者中,腹壁内异症患者22例,均有剖宫产手术史,会阴EP切口内异症8例。均有典型周期性腹痛,肿块,手术切除均取得良好效果,未有复发。结论子宫内膜异位种植是本症的主要发病机制。根据典型的症状、体征,结合B超可正确诊断。彻底手术是唯一确实有效的治疗方法。     

腹壁子宫内膜异位症的临床资料分析

目的:分析腹壁子宫内膜异位症临床资料,探讨有效的治疗方法和预防措施。方法:回顾性分析233例腹壁子宫内膜异位症的临床资料,应用t检验、字2检验、多因素方差分析分析临床资料。结果:233例腹壁子宫内膜异位症,均为腹部术后腹壁瘢痕子宫内膜异位症。患者年龄≥35岁的潜伏期长于年龄<35岁者,差异有统计学意义（P<0.05）。腹膜型结节大小大于筋膜型以及肌肉型（P<0.05）。血清CA125值有助于腹壁子宫内膜异位症分型:筋膜型>前鞘肌肉型>腹膜型,术后是否追加GnRHa治疗对于术后复发差异无统计学意义。结论:超声和CA125值有助于腹壁子宫内膜异位症的诊断与分型,手术治疗中广泛的局部切除和切缘阴性是预防复发的关键。     

腹壁、会阴切口子宫内膜异位症12例分析

目的探讨腹壁、会阴子宫内膜异位症的病因、诊断及治疗。方法对本院确诊的12例腹壁、会阴子宫内膜异位症进行临床分析。结果子宫内膜异位种植是本病的主要发病原因;切口部位月经期周期性发作性包块为其主要临床特点及诊断依据治疗首选手术切除病灶。结论尽量避免和减少子宫内膜组织散落和遗留在手术切口是预防本病的关键,手术切除病灶是治疗本病的首选方法。     

腹壁及会阴子宫内膜异位症25例临床分析

目的探讨腹壁及会阴子宫内膜异位症临床特征及治疗。方法分析25例盆腔外子宫内膜异位症的临床资料,其中20例为腹壁子宫内膜异位症,5例为会阴子宫内膜异位症。结果其发病的潜伏期多在1-3年。据病史及临床表现,术前多可确诊。本组病例均行手术切除病灶。随访20例,随访时间0.5-5年,均无复发。结论腹壁及会阴子宫内膜异位症行病灶切除为其主要治疗方法。     

腹壁子宫内膜异位症再次手术5例原因分析

目的探讨腹壁子宫内膜异位症(abdominal wall endometriosis,AWE)再次手术病例的临床特点。方法回顾性总结分析1992~2005年间我院收治的101例AWE患者的临床资料,分为再次手术组5例,未再次手术组96例。分析比较2组临床特点。结果再次手术组1例为反复发作的AWE,逐步演变为不典型子宫内膜异位症;1例患者再次手术切除的AWE位于初次手术的另一侧,此部位有经期疼痛症状,应属于遗漏;其余3例患者首次手术均距病灶边缘0.5cm切除。再次手术组术前扪诊和B超检查AWE病灶均显著大于未再次手术组(P<0.05),而2组手术切除病灶大小差异无显著意义(P>0.05),可能与再次手术组的病例切除病灶外的组织较少有关。结论手术切除AWE病灶时,应根据术前患者的症状,对可疑部位进行仔细探查,避免较小病灶的遗漏。切除病灶尽可能距病灶边缘1cm以上。对于病程长、反复发作的AWE,要警惕其恶变。     

第2跖趾关节痛风性关节炎并发先天性短指(趾)畸形1例报告

目的: 报道1例第2跖趾关节痛风性关节炎并发先天性短指(趾)畸形病例,并对其诊疗情况进行讨论。方法: 该男性17岁患者因右足第2跖趾关节反复肿痛6个月入院,诊断为先天性短指(趾)畸形,右第2跖趾关节痛风性关节炎,手术行痛风石切除和关节成形术。结果: 患者术后恢复顺利,疼痛消失,恢复正常行走。结论: 痛风可并发足部畸形,临床上需注意鉴别诊断,手术治疗可获得良好效果。     

Combined vesical and abdominal endometriosis following abdominal hysterotomy and tubal ligation

The article reports on the case of a 29 year old patient who developed abdominal endometriosis 4 years after having had hysterotomy and tubal ligation. About a month after the excision of the endometrial tissue she was examined for suprapubic pains, strangury, and frequency of micturition. A nodule was found in the deepest part of the abdominal wall and the patient was treated for 6 months, without success, with medroxyprogesterone acetate. A subsequent laparotomy showed bladder endometriosis, obviously still an endometrial implant at the time of hysterotomy, which was missed at the time of the first excision. Total hysterectomy was carried out and the patient recovered successfully. Bladder endometriosis is the most common site of involvement among urinary tract endometriosis. The peculiarity of the case presented here is in the total absence of hematuria, and in the fact that pains had no relation with the menstrual cycle. Hormonal therapy is often ineffective, and surgery often the only advisable form of treatment.     

剖宫产术后腹壁切口子宫内膜异位症20例

目的:探讨剖宫产术后腹壁切口子宫内膜异位症的临床特点、诊治方法和预防措施。方法:对经手术和病理证实的20例剖宫产术后腹壁切口子宫内膜异位症患者的临床资料进行回顾性分析。结果:所有的患者均行病灶切除术,术后均无复发。结论:手术切除病灶是剖宫产术后腹壁切口子宫内膜异位症唯一有效的治疗方法,而术中尽量避免和减少子宫内膜组织散落和遗留手术切口是预防本病的关键。     

椎间盘源性腰痛的手术治疗

目的：研究腰椎间盘源性腰痛的手术疗效。方法：42例腰椎间盘源泉性下腰痛患者选择腰椎体间融合术进行治疗，其中12例行后路椎体间植骨融合椎弓根螺钉系统内固定术（posterior lumbar interbody fusion，PLIF），30例行前路髓核摘除植骨融合术（afront lumbar interbody fusion，ALIF）。分别于术前、术后对病人的腰痛情况进行视觉疼痛自我评定尺（visual analogue scale，VAS）评分，同时评估术后腰椎融合率。结果：术后随访时间6～36个月，平均18个月。在12例行PLIF者中，11例术后腰腿病症状基本消失，1例仍有轻度腰痛，术前、术后VAS腰痛评分的差异有统计学意义（P〈0．01）。在30例行ALIF患者中，28例腰腿痛症状基本消失，术前、术后VAS腰痛评分的差异有统计学意义（P〈0．01）。行PLIF患者的融合率为90％，行ALIF患者的融合率93％。结论：严格掌握手术适应证，腰椎椎体间融合术是治疗腰椎间盘源性下腰痛的有效方法。     

胰腺实性假乳头状瘤18例的诊断与治疗

目的回顾18例胰腺实性假乳头状瘤(SPPT)的临床病理特点及治疗,以求建立最佳诊断方法及手术治疗方案。方法回顾近6年18例SPPT患者的术前、手术、术后资料,包括年龄、性别、症状体征、实验室检查、手术、病理及复发和预后情况。结果 18例患者中女性15例,年龄11~43岁,平均26.5岁;男性3例,年龄23~53岁,平均39.7岁。其中11位患者表现为腹痛或腰痛,其余患者无症状。所有患者均没有特异的实验室检查阳性结果,肿瘤标记物均基本正常。所有患者均获得手术切除肿瘤。平均术后住院日8.7 d(6~16 d),18例均存活良好无复发,随访时间3~58个月。结论该研究证实SPPT是多发于青年女性的少见肿瘤。手术切除是治愈该疾病的治疗方式。无论肿瘤的大小及位置如何,一般手术均可以达到治愈效果,术后复发非常少见。