盆腔手术后腹壁子宫内膜异位症93例临床分析

目的 分析盆腔手术后腹壁子宫内膜异位症（AWE）患者的临床特点。方法 回顾性分析2011年1月至2017年12月安徽医科大学第一附属医院收治的93例盆腔手术后病理确诊的AWE患者临床资料，对患者的临床表现、影像学特征、手术治疗方法及疗效进行分析。结果 93例患者中，58.1%的患者以腹壁切口旁包块为首发症状，41.9%以经期腹壁切口包块疼痛为首发症状；88.2%的患者为单个包块，11.8%为多个包块；64.44%的患者包块位于横切口两侧，35.48%位于纵切口上下端。70例行超声检查的患者中，50.53%包块呈椭圆形或圆形低回声，无包膜；24.73%包块为边界不清晰的高回声区，伴有小的无回声区。23例行MRI检查的患者中，19.35%病灶边界模糊，13.98%包块呈实质性团块，T₁WI上高信号和T₂WI上混杂信号；10.75%包块呈囊实性团块，T₁WI以等低信号为主，T₂WI呈高低混杂信号，增强扫描后病灶均可见明显强化。所有患者均采用经腹手术切除病灶，术后切口Ⅰ期愈合，门诊随访6～85个月，复发5例。结论 盆腔手术后AWE患者主要以腹壁切口处包块为首发症状，部分伴有经期疼痛；超声检查多为无包膜、边界不清的异常回声团块；MRI检查病灶呈多种混杂信号，增强扫描后明显强化。经腹手术切除病灶，效果良好。

Clinical analysis of 93 cases of abdominal wall endometriosis after pelvic surgery

Objective To analyze the clinical characteristics of patients with abdominal wall endometriosis (AWE) after pelvic surgery.Methods The clinical data of 93 patients with AWE after pelvic surgery were collected from January 2011 to December 2017 in the First Affiliated Hospital of Anhui Medical University, and these data were retrospectively analyzed, including the clinical signs, image features, surgical treatment and efficacy.Results Among 93 patients, 58.1% of them had a mass beside the abdominal wall incision as the first symptom, and 41.9% of them had a pain in the abdominal wall incision during menstruation as the first symptom.In addition, 88.2% of the patients had a single mass and 11.8% had multiple masses; 64.44% of the masses were located on both sides of the transverse incision and 35.48% were located on the upper and lower ends of the longitudinal incision. Among the 70 patients who underwent ultrasonic examination, 50.53% of the masses were oval or round with hypoechoic image andnocapsule; 24.73% of the masses were hyperechoic areas with unclear boundaries and small anechoic areas. Among the 23 patients who underwent MRI examination, 19.35% of the lesions had blurred boundary; 13.98% showed solid mass with high signal intensity on T₁WI and mixed signal intensity on T₂WI; 10.75% of the lesions showed cystic and solid masses, mainly isohypointensity on T₁WI, and mixed hypointensity on T₂WI.The lesions were significantly enhanced after enhanced scanning. All patients were treated by abdominal surgery and the incisions were healed by first intention. All patients were followed up for 6~85 months and 5 cases recurred.Conclusions The primary symptom of AWE patients after pelvic surgery is abdominal incision mass, and some of them are accompanied with menstrual pain.Ultrasonography shows abnormal echo mass without capsule and unclear boundary. On MRI, the lesions show mixed signal intensity and are significantly enhanced after contrast enhancement.The therapeutic effect of transabdominal resection is good.