疤痕子宫再次剖宫产术后腹壁子宫内膜异位症48例临床分析

Clinical analysis of 48 cases of abdominal wall endometriosis after repeat cesarean section in scarred uterus

目的探讨疤痕子宫再次剖宫产术后腹壁子宫内膜异位症(AWE)的临床特征、分型、治疗及预后。方法回顾性分析2010年1月1日至2019年12月31日深圳市宝安区妇幼保健院产科收治的48例AWE患者的临床资料。根据病灶浸润程度分为皮下型、鞘膜型、腹膜型,根据是否合并盆腔子宫内膜异位症将患者分为单纯型和复杂型,根据病灶个数分为单发型和多发型,比较AWE各分型患者的血清CA125水平,分析所有患者的超声诊断结果,分析患者的肿块位置、包块径线、病灶位置等术中情况以及患者术后病理诊断、并发症发生情况及预后情况。结果皮下型、鞘膜型、腹膜型患者的血清CA125以及单纯型、复杂型患者的血清CA125水平比较差异均有统计学意义(P<0.05),而单发型和多发型患者的血清CA125水平比较差异无统计学意义(P<0.05);术前,所有患者均行超声检查,结果显示:具有1个病灶患者41例,具有2个病灶患者7例,病灶平均径线(2.15±0.12)cm;病灶侵入皮下层44例,脂肪层2例,肌层2例;术中显示,肿块位于皮下4例,占8.3%,位于脂肪层15例,占31.3%,位于腹直肌鞘外18例,占37.5%,位于肌层3例,占6.3%,位于腹膜外5例,占10.4%,位于腹腔3例,占6.3%;术中显示,包块最大径线范围0.7~6.8 cm,平均(2.64±0.18)cm;97.9%病灶位于腹壁切口的边缘,2.1%位于切口的中央;所有患者术后病理诊断均为子宫内膜异位病灶,切缘阴性,且术后均愈合良好,未有其他并发症。结论AWE应做到早发现早治疗,CA125对其分型具有临床指导意义,超声检查和典型的临床症状可作为AWE的诊断方法。

Objective To investigate the clinical characteristics,classification,treatment and prognosis of abdominal wall endometriosis(AWE)after repeat cesarean section in scarred uterus.Methods The clinical data of 48 patients with AWE treated in Department of Obstetrics,Shenzhen Bao'an District Maternal and Child Health Hospital from January 1,2010 to December 31,2019 were analyzed retrospectively.According to the degree of lesion infiltration,the patients were divided into subcutaneous type,sheath type and peritoneal type.According to whether they were complicated with pelvic endometriosis,the patients were divided into simple type and complex type.According to the number of lesions,they were divided into single type and multiple type.The levels of serum CA125 in patients with different types of AWE were compared,and the ultrasonic diagnostic results of all patients were recorded.The intraoperative conditions such as mass location,mass diameter and lesion location,as well as the postoperative pathological diagnosis,complications and prognosis were recorded.Results There was significant difference in serum CA125 levels among patients with subcutaneous type,sheath type and peritoneal type,and patients with simple type and complex type(P<0.05);However,there was no significant difference in serum CA125 levels between patients with single type and multiple types(P>0.05).All patients underwent ultrasonography before operation.The results showed that there were 41 patients with one lesion and 7 patients with two lesions.The average diameter of the lesion was(2.15±0.12)cm;the lesions invaded subcutaneous layer in 44 cases,adipose layer in 2 cases,and muscular layer in 2 cases.During the operation,the masses were located subcutaneously in 4 cases,accounting for 8.3%,in the adipose layer in 15 cases,accounting for 31.3%,outside the rectus abdominis sheath in 18 cases,accounting for 37.5%,in the muscular layer in 3 cases,accounting for 6.3%,outside the peritoneum in 5 cases,accounting for 10.4%,and in the abdominal cavity in 3 cases,accounting for 6.3%.The intraoperative results showed that the maximum diameter of the mass ranged from 0.7 cm to 6.8 cm,with an average of(2.64±0.18)cm.97.9% of the lesions were located at the edge of the abdominal incision,and 2.1% at the center of the incision.All patients had a postoperative pathological diagnosed as endometriosis lesions,negative cut edge,and healed well after operation without other complications.Conclusion Abdominal wall endometriosis should be found early and treated early,and CA125 has clinical guiding significance for its classification.Ultrasound examination and typical clinical symptoms can be used as diagnostic methods for AWE,and have clinical application value.