剖宫产术后腹直肌肿物的CT分析

CT analysis of rectus abdominis mass after cesarean section

目的：分析剖宫产术后腹直肌切口肿物的CT影像表现，探讨诊断思路及CT影像特征。方法对25例经病理证实的剖宫产术后腹直肌肿物CT表现进行回顾性分析。所有患者临床资料完整，均行多排螺旋CT平扫加增强检查。结合其临床资料（包括剖宫产术式、术后出现腹直肌肿物的时间、肿物触诊情况等）和CT影像特征进行归纳总结。结果25例均为腹直肌单发肿物，病灶位于切口处腹直肌内。（1）子宫内膜异位症8例。出现症状时间为剖宫产术后9～48个月，CT表现为腹直肌内实性或囊实性结节，增强囊壁及实性部分明显强化。（2）韧带样瘤6例。出现症状时间为剖宫产术后12～36个月，触诊为质硬无痛性包块；6例密度均等于或稍低于肌肉，均呈渐进性强化；5例呈梭形与腹直肌长轴一致。（3）脓肿7例。出现症状为剖宫产术后2～4周，触诊边界不清，CT表现为不规则软组织肿块，内见气－液平面，增强呈环形强化。（4）血肿4例。出现症状为剖宫产术后2周内，肿物呈梭形局限于腹直肌内，边界清楚，增强后无强化，周围可见新生血管。结论剖宫产术后腹直肌肿物是一组与手术相关的疾病，结合发病时间和临床特征，根据 CT 影像表现，能作出较准确的诊断。

Objective To assess the CT features of mass in the rectus abdominis after cesarean section. Methods Non contrast and enhanced CT of 25 women with pathologically proven rectus abdominis masses after cesarean sections was retrospectively analyzed. The medical history including the time between the cesarean section and onset of symptoms as well as findings on physical examination was reviewed. Results The 25 masses in the rectus abdominis included endometriosis （8）,. desmoid tumors（6）, abscesses （7）, and hematomas （4） with onset of symptoms at 9-48 months, 12-36 months, 0.5-1 month, and 2 weeks after cesarean sections,.respectively..CT of endometriosis showed solid ormixed cystic-solid masses with marked contrast enhancement in the anterior abdominal wall adjacent to the cesarean incision..The desmoid tumors were painless,.firm and non-mobile masses on palpation with CT hypodensities and gradual contrast enhancement. The masses （5/6） enlarged with time in spindle shapes parallel to the long axis of the rectus abdominis muscles. The borders of the abscesses were indistinct on palpation. CT showed irregular soft tissue masses containing necrosis or gas and peripheral enhancement.The hematomas were seen on CT as well-defined non-enhancing masses with surrounding neovascularity. Conclusion Rectus abdominis masses after cesarean section can be accurately diagnosed on CT combined with the medical history.