腹壁子宫内膜异位症31例临床分析

A clinical analysis of abdominal wall endometriosis in 31 cases

目的：探讨腹壁子宫内膜异位症的临床特点、治疗方法和预后。方法：回顾性分析1999～2007年本院收治的31例腹壁子宫内膜异位症病例的临床资料，足月剖宫产史26例，就诊年龄（28．8±9．2）岁，发病时间为术后3个月～6年，均有程度不同的经期切口瘢痕处胀痛症状。行手术切除26例，药物保守治疗5例。结果：行手术切除病灶的26例患者术后无一例复发，切除病灶直径平均4．0cm，显著大于术前扪诊和超声测量的1．0～2．0cm（P〈0．01）。医源性内膜种植引起切口异位症占0．05％。31例腹壁子宫内膜异位症治疗后随访，药物保守治疗者停药后均有不同程度的症状反复。结论：手术后腹壁子宫内膜异位症的发生与手术引起的医源性内膜种植有关，治疗首选手术，B超用于术前测量病灶大小及病灶的浸润范围。复发后可再次手术。腹壁子宫内膜异位症治疗最重要的在于预防。

Objective： To investigate the clinical characteristics, treatments and prognosis of abdominal wall endometriosis. Methods： A retrospective analysis was performed on 31 patients with abdominal wall endo metriosis （AWE） hospitalized in our hospital between 1999-2007. Results： Of 31 patients with AWE, 26 had a history of caesarean section, with an abdominal wall mass （average 1.5 cm） at the first visit. Their mean age was （28.8±9.2） years. 89.8% of patients had a menses related cyclically painful mass. The incidence of abdominal wall endometriosis in the patients undergoing caesarean delivery in our hospital was 0.05%. AWE was diagnosed before surgery in 92.1% of patients . The mean size of the lesions resected was 4.0 cm, significantly larger than that measured by pre-operational palpation or ultrasonography （about 1.0-2.0 cm） （P 〈0.01 ）. Conclusion： B-ultrasonography can be used to measure the size of mass and define the infiltrative. Surgical excision of AWE with at least 1cm outside the edge of AWE, combined with pre-surgical and post-surgical medication, should be the first choice. Preventation is iomportent.