剖宫产腹壁切口子宫内膜异位症30例临床分析

A clinical analysis of 30 cases of abdominal incisional endometriosis after cesarean section

目的：探讨剖宫产术后腹壁切口子宫内膜异位症的临床诊断及治疗情况。方法选取2005年10月～2012年8月经手术治疗腹部切口子宫内膜异位的患者30例，对30例患者的临床资料进行回顾性分析。结果30例腹部切口子宫内膜异位症患者4例病灶累及腹膜，5例累及肌层，14例累及腹肌前鞘。行异位病灶切除手术，手术效果良好，无复发。手术患者病灶均为一次手术切除，30例手术的患者完全治愈,治愈率100%。病理检查增生的结缔组织中可以见到子宫内膜腺体结构及间质细胞。符合子宫内膜异位症的诊断。术后23例患者随访1～3年，无复发病例。结论剖宫产手术是腹壁切口子宫内膜异位症最重要的医源性因素,应严格依照剖宫产手术适应证可降低剖宫产率，手术是唯一有效的治疗方法；规范手术操作是预防本病发生的关键。

Objective To explore the clinical diagnosis and treatment of abdominal incisional endometriosis after cesarean section.Methods 30 patients who received surgery of abdominal incisional endometriosis from October 2005 to August 2012 were selected.Clinical data of the 30 patients were retrospectively analyzed.Results 4 of 30 patients with abdominal incisional endometriosis had foci involving peritoneum,5 involving muscular layer,and 14 involving protheca of abdominal muscle.Incision of ectopic foci was carried out and the surgical effect was good without any relapse.All patients received the incision of foci only once.All the 30 patients completely recovered with the recovery rate of 100%.Hyperplastic connective tissues via pathological examination showed endometrial glandular structure and interstitial cells.The results accorded with the diagnosis of endometriosis.23 patients received follow-ups after the surgery for 1-3 years,and no relapses were detected.ConclusionCesarean section is the main iatrogenic factor causing abdominal incisional endometriosis.Treatment strictly following surgical indications of Cesarean section helps reduce the rate of Cesarean section, and surgery is the only effective treatment for endometriosis;standardized surgical procedures are the key to prevent the disease.