探讨剖宫产术后腹壁切口子宫内膜异位症的治疗方法

目的：探讨腹壁子宫内膜异位症的临床特点、治疗方法和预防措施。方法：回顾性分析2008年～2010年本院收治的30例具有足月剖宫产史的手术病例，其中89．9％患者在月经期间腹壁肿物有周期性疼痛，就诊年龄（33．3±4．8）岁，就诊时距剖宫产（70．2±44．7）月。30例病例分为A实验组17例和B对照组13例，A实验组于腰硬联合麻醉下行病灶切除术，术后未应用治疗子宫内膜异位症方面药物；B对照组口服孕三烯酮2．5mg，每周2次，6个月，对所有患者在治疗后2年内每年随访2次，以评价治疗效果。结果：实验组术前诊断均与术后病理检查相符，术后无复发，术后切口均为Ⅰ期愈合，7d正常拆线出院。对照组7例发生闭经，1例存在肝功能损伤，实验组治愈率明显高于对照组，差异有统计学意义（P〈0．05）。结论：剖宫产术后腹壁切口子宫内膜异位症治疗首选手术切除，术前严格掌握剖宫产指征，术中认真操作是关键，同时提倡该种疾病以预防为主。

Treatment Method of Abdominal Wall Endometriosis After Cesarean Section

Objective： To study the clinical characteristics, treatment and precaution of abdominal wall en- dometriosis （AWE） occurring after cesarean section. Methods： A retrospective study of 30 patients diagnosed as AWE after cesarean section from 2008 to 2010 at obstetric and gynecologic department of Xi＇an red cross hospital were recorded and analyzed. The mean age of the patients was （33.3±4.8） years and the mean interval from the original cesarean section to presentation with mass was （70.2±44.7） months. Abdominal wall mass associated cyclical pain during the menstrual cycle was noted in 89.8% of the patients. Thirty cases of AWE were randomly separated into group A （17 cases） and B （13 cases）. All the patients of group A un- derwent surgical treatment and their masses were completely excised under combined spinal-epidural anes- thesia, no medication was given after surgery. 13 patients of group B took 2.5mg gestrinone, twice a week for six months. All patients were followed-up for 2 years, biannual examinations were taken to observe the effect of treatment. Results： The pathological examination of group A patients proved endometriosis after the surgical resection, without recurrence after operation and all of the incision of patients were primary healing, and discharged after 7 days. 7 patients of group B occurred amenorrhoea and 1 patient had damage of liver function, the cure rate of group A was higher than that of group B, the differences has a statistical signifi- cances （P〈0.05）. Conclusion： Surgical excision is the first effective treatment for AWE, Strictly controlling the indications of cesarean section and thorough operation of affected area are the key for treatment of the endometriosis in incisional scar of abdominal wall and the main measure to prevent recurrence after opera- tion. Meanwhile, effective preventive strategies for AWE should be recommended.