剖宫产术后腹壁子宫内膜异位症手术119例临床分析

目的:探讨剖宫产术后腹壁子宫内膜异位症(AWE)的临床特点、治疗和预防。方法:回顾分析剖宫产术后AWE 119例的临床资料,患者的一般情况,发病症状和时间,手术情况,药物治疗,随访和复发。结果:患者平均年龄32.40±4.25岁,24～39岁占91.6%,94.12%表现为腹壁肿块,86.55%出现疼痛,剖宫产术与出现腹壁肿块平均间隔29.46±24.29月,病灶直径平均3.14±1.14cm,平均1.15±0.465个,横切口单个病灶右侧占46.15%,左侧占34.07%,病灶深部累及部位依次为:腹直肌前筋膜61.34%,腹膜15.97%,肌层12.61%,皮下脂肪层10.08%。106例行单纯病灶切除,合并其他手术13例,手术时间34.54±12.81min,术中出血31.37±25.58ml,切口均一期愈合。合并盆腔子宫内膜异位症5例,占腹腔探查32例的15.63%。5例术前药物治疗,停药后症状复发。119例术后5例复发,复发率4.20%。结论:AWE具有典型的临床表现,手术是唯一有效的治疗方法,AWE好发于切口的两侧角部,采取预防措施可防止发生。

Clinical analysis of 119 cases operation of abdominal wall endometriosis after cesarean section

Objective:To analyze the clinical characteristics,treatment and prevention of abdominal wall endometriosis(AWE) after cesarean section.Methods:A retrospective study was performed on 119 cases of operation of AWE after cesarean section.The general situation,symptoms,duration of disease,surgical status,medical therapy,follow-up and recurrence were analyzed.Results:The mean age of patients was 32.40±4.25 years.94.12% presented with a mass,86.55% presented with pain.The mean interval from the original surgery to presentation with mass was 29.46±24.29 months.The mean diameter of mass was 3.14±1.14cm and the mean number was 1.15±0.465.For single mass in the pfannenstiel incision scar,46.15% were on the right side and 34.07% were on the left side.The deeply Infiltrating tissues of masses:fascia 61.34%,peritoneum 15.97%,muscle 12.61%,subcutaneous layer 10.08%.106 cases were performed with wide local excision and 13 cases were also performed with other operation.The mean operation time and blood loss were 34.54±12.81min,31.37±25.58ml.5 cases had pelvic endometriosis(15.63% of abdominal exploration).5 received pre-operative medical management but symptoms recurred after stopping taking medicine.The recurrence rate of 119 cases was 4.20%.Conclusion:AWE has a typical clinical presentation,AWE were common at corner site of the scar after cesarean section.Surgical excision was the only effective treatment,meanwhile,effective preventive strategies for AWE should be recommended.