侵犯耻骨的腹壁子宫内膜异位症一例并文献复习

A Case of Abdominal Wall Endometriosis Involving Pubic Bone and Literature Review

报告1例侵犯耻骨的腹壁子宫内膜异位症经手术治疗成功的病例。该患者经腹壁超声、盆腔磁共振成像检查,以及经细针穿刺病理检查后明确诊断。入院后成立了由妇科、普外科、疝外科、骨科和泌尿外科组成的多学科团队,经过讨论建议手术切除腹壁子宫内膜异位症肿块,并由多学科治疗团队完成。术中发现腹壁肌肉、腹膜和耻骨联合均有子宫内膜异位组织浸润。手术完整切除腹壁及耻骨的子宫内膜异位症肿块,因腹部肌肉及筋膜切除较多,腹壁缺损无法常规缝合,予以补片修补腹壁缺损。患者术后恢复良好,无并发症,随访顺利。本病例的成功治疗表明充分的术前检查和多学科治疗团队的合作是治疗复杂腹壁子宫内膜异位症患者的关键。对于侵犯耻骨的子宫内膜异位症,利用无张力疝修补技术及术后加压包扎,可作为腹壁缺损的一种可选治疗方法。

A case of abdominal wall endometriosis involving pubic bone was successfully treated by surgical.The patient was diagnosed by abdominal wall ultrasound,pelvic magnetic resonance imaging and finally confirmed by fine needle biopsy.After admission,a multidisciplinary team including gynecologists,general surgeons,hernia surgeons,orthopedic surgeons and urologists was established to discuss and recommend surgical removal of abdominal wall endometriosis mass.The operation was completed by the multidisciplinary treatment team.Endometriosis was found in abdominal wall muscle,peritoneum and pubic symphysis.The endometriosis mass in the abdominal wall and pubic bone was completely removed.Because there were many abdominal muscles and fascia excised,the abdominal wall defect could not be sutured routinely.The abdominal wall defect was repaired with patches.The patient recovered well without complications and was followed up well.The successful treatment of this case showed that adequate preoperative examination and the cooperation of multidisciplinary treatment team were the key to the treatment of patients with complex abdominal wall endometriosis.For endometriosis involving pubic bone,tension-free hernia repair technique and postoperative compression bandage can be used as an alternative treatment for abdominal wall defect.