86例剖宫产术后腹壁子宫内膜异位症病灶分布的临床分析

The Distribution Characteristic of Abdominal Wall Endometriosis Lesions after Cesarean Section: a Clinical Analysis of 86 Cases

目的 探讨剖宫产术后腹壁子宫内膜异位症（abdominal wall endometriosis，AWE）的病灶特点，探讨相应的防范措施。方法 2002年2月～2011年8月对86例剖宫产术后AWE，在腰硬联合麻醉或全身麻醉下在病灶外0.5～1cm逐层切开病灶周围组织，至病灶及其周边组织完全切除，探查无其他病灶存留，生理盐水冲洗手术创面，可吸收线间断缝合，关闭筋膜、皮下脂肪层，皮内缝合皮肤。结果病灶直径0.8～7.0cm，平均3.2cm。单个病灶78例，≥2个病灶13例，共切除94个病灶；86个病灶（91.5％，86／94）位于切口两侧，8个病灶（8.5％，8／94）位于切口中间。病灶累及腹壁组织：脂肪＋筋膜占51.2％（44／86），筋膜＋肌层占16.3％（14／86）。病灶大小直径平均3.2cm（0.8～7.0cm）。术后病理结果均为腹壁子宫内膜异位症。61例随访2～118个月，复发率11.5％（7／61），无恶变。结论剖宫产术后AWE病灶多位于切口两侧，并累及脂肪、筋膜及肌层。在剖宫产术中需要保护切口，彻底冲洗腹壁切口。

Objective To analyze the distribution characteristic of abdominal wall endometriosis after cesarean section, and discuss the precautionary measure. Methods The clinical data of 86 cases admitted to our hospital for surgery due to abdominal wall endometriosis after cesarean section between February 2002 and August 2011 were collected and analyzed. The patients received combined spinal-epidural anesthesia or general anesthesia. The surrounding tissue away from the lesion by 0.5 to 1 em was incised layer by layer, until the lesion was removed completely. The wounds were douched with normal saline when no lesions remained. The fascia and subcutaneous adipose layer were dosed by interrupted sutures with absorbable thread, and the skin by intradermal sutures. Results All cases with 94 lesions（ 13 cases had more than one lesion） underwent local lesion resection; 91.5% （86/94） of the lesions were located on both sides of the incisions and 8.5% （8/94） in the middle. In 44 cases （51.2% , 44/86）, the fat and fascia of abdominal wall were mainly involved; in 14 cases （16.3%, 14/86）, fascia and muscular were involved. All lesions were pathologically confirmed. A total of 61 patients were followed up for 2 to 118 months, and the recurrence rate was 11.45% （7/61） , without malignant transformation in all cases. Conclusions Most of the abdominal wall endometriosis lesions after cesarean section are located on both sides of the incisions, with fat, fascia and muscular being involved. It is recommended to protect the incision intraoperatively and thoroughly wash the incision.