335例剖宫产切口部位子宫内膜异位症的临床分析

Clinical analysis of 335 cases of cesarean scar endometriosis

目的 分析剖宫产切口部位子宫内膜异位症(CSE)的临床特征与分型情况。方法 回顾性分析2016年1月至2022年6月该院收治的335例CSE患者临床资料,分析病灶最大径与其他临床指标的相关性,比较不同病变分型患者的临床特征。结果 335例患者发病年龄为(30.2±4.2)岁,潜伏期为1个月至15年,平均(35.7±29.3)个月。328例患者接受手术治疗,48例(14.6%)患者既往剖宫产次数≥2次,既往剖宫产次数≥2次者发病年龄和病灶最大径高于1次者,差异有统计学意义(P<0.05)。按病灶侵及深度将患者分为皮下型26例、鞘膜型271例和腹膜型31例,病灶最大径腹膜型>鞘膜型>皮下型,差异有统计学意义(P<0.05);腹膜型血清糖类抗原125(CA125)水平、术中出血量、使用引流管和补片的比例均明显高于皮下型和鞘膜型(P<0.05)。病灶最大径与孕次、剖宫产次数、病程、术中出血量、病灶侵及深度及使用引流管、补片的比例呈正相关(P<0.05)。结论 剖宫产次数在一定程度上影响CSE患者的病灶大小,腹膜型患者的病灶较大,术中出血量和使用补片比例较高,应引起临床重视。

Objective To analyze the clinical characteristics and typing of cesarean scar endometriosis(CSE).Methods The clinical data of 335 cases of patients with CSE admitted to this hospital from January 2016 to June 2022 were retrospectively analyzed.The correlation between the maximum diameter of the lesions and other clinical indicators was analyzed,and the clinical characteristics were compared among the patients with different subtypes of lesions.Results The mean age of onset in 335 patients was(30.2±4.2)years,and the incubation period ranged from 1 month to 15 years,with a mean of(35.7±29.3)months.A total of 328 patients received surgical treatment,and 48 patients(14.6%)had two or more previous cesarean sections.The age of onset and maximum diameter of the lesions in patients had two or more previous cesarean sections were higher than those in patients had one previous cesarean section,and the difference was statistically significant(P<0.05).The patients were divided into 26 cases of subcutaneous type,271 cases of sheath type,and 31 cases of peritoneal type according to the depth of lesion invasion.The maximum diameters of the lesions were the peritoneal type>sheath type>subcutaneous type,and the differences were statistically significant(P<0.05).The serum level of CA125,amount of intraoperative blood loss,and proportions of patients using drainage tubes and patches in the peritoneal type were significantly higher than those in the subcutaneous type and sheath type(P<0.05).The maximum diameter of the lesions was positively correlated with gravidity,cesarean section frequency,course of disease,amount of intraoperative blood loss,depth of lesion invasion,and proportions of patients using drainage tubes and pat ches(P<0.05).Conclusion The cesarean section frequency influences the lesion size of patients with CSE to a certain extent.Patients with the peritoneal type have larger lesions,higher amount of intraoperative blood loss,and higher proportions of patches use,which should be of clinical concern.