79例腹壁子宫内膜异位症临床资料分析

发布时间：2018-03-29 09:55

  本文选题：剖宫产术　切入点：腹壁子宫内膜异位症　出处：《吉林大学》2014年硕士论文

【摘要】：背景和目的：子宫内膜异位症(endometriosis, EMT)，简称“内异症”，是指具有生长功能的子宫内膜组织(腺体和间质)出现在子宫腔被覆内膜及宫体肌层以外的其他部位。该病属于良性疾病，但因其表现有增生、浸润、转移等的恶性生物学行为，故有“良性癌”之称。该病好发于盆腔内，以卵巢最为常见，盆腔外比较少见。腹壁子宫内膜异位症(abdominal wall endometriosis,AWE)是最常见的盆腔外子宫内膜异位症,最多见于剖宫产术后切口瘢痕处，，国内研究表明,剖宫产术后AWE发生率0.03%~0.47%。近年来，我国剖宫产手术率一直居高不下,腹壁子宫内膜异位症的发病率也开始逐年增高，给患者的身心带来痛苦，同时也增加了经济负担。本研究回顾性分析2009年2月至2013年7月在吉林大学白求恩第一医院收治的79例腹壁子宫内膜异位症患者的临床资料，探讨影响腹壁子宫内膜异位症的发生、临床特点以及预后的相关因素，希望为今后减少腹壁子宫内膜异位症的发病率及术后复发率提供参考。 方法：对已行手术切除病灶并有术后病理明确诊断的79例剖宫产术后AWE患者的临床资料进行回顾性分析并电话随访，收录结果经SPSS17.0软件进行统计学分析。 结果： 1.线性回归分析提示该病潜伏期与发病年龄呈正相关(r=0.326，P=0.003)，其差异有统计学意义；潜伏期与剖宫产年龄、月经周期呈负相关，但其差异均无统计学意义。 2.发病年龄30岁(39例)的研究对象其发病潜伏期与年龄≤30岁者(40例)相比，时间明显延长，差异具有统计学意义(t=-2.217,P=0.03)；月经周期≥28天的研究对象（62例）其发病潜伏期较周期＜28天者（17例）时间长，影响差异具有统计学意义（t=-2.639，P=0.01）；而剖宫产年龄＞30岁（9例）的患者与年龄≤30岁（70例）的患者对发病潜伏期影响无显著性差异（t=1.206，P=0.208）。 3.79例患者均于术前诊断为腹壁子宫内膜异位症，治疗方法为行手术切除病灶，术中切缘距病灶边缘0.5-1.0cm，术后追加药物辅助治疗的患者19例。 4.79例研究对象中仅有63例成功随访，其中20.6%（13/63）再次出现瘢痕处疼痛，有2例研究对象切口周围可触及明显包块，与月经周期有关，临床诊断为AWE复发。13例复发患者中：有3例患者术中病灶＞3cm；有9例为横行剖宫产切口；有9例术后未追加药物辅助治疗。 结论： 1.严格控制剖宫产指征，降低剖宫产率是降低AWE发病率的关键。 2.腹壁子宫内膜异位症患者的发病年龄及月经周期是该病潜伏期的影响因素，而患者的剖宫产年龄与该病无明显相关性。 3.腹壁横切口的AWE患者其发病率及复发率均高于纵切口，支持异位内膜种植学说，故剖宫产切口的选择及其术中切口的保护成为降低AWE发病率和复发率的另一重要因素。
[Abstract]:Background & AIM: endometriosis endometriosis (EMTA) refers to the presence of endometrial tissues (glands and stroma) with growth function in other parts of the uterine cavity other than the endometrium and the myometrium of the uterine body. The disease is a benign disease. However, it is known as "benign cancer" because of its malignant biological behavior such as hyperplasia, infiltration, metastasis, etc. The disease is common in the pelvic cavity, especially in the ovary. Endometriosis of abdominal wall wall endometriosis is the most common pelvic endometriosis, most commonly seen in scar of incision after cesarean section. Domestic studies show that the incidence of AWE after cesarean section is 0.03 and 0.47. In recent years, The rate of cesarean section is always high in our country, and the incidence of endometriosis in the abdominal wall is increasing year by year, which brings pain to the patients' body and mind. From February 2009 to July 2013, we retrospectively analyzed the clinical data of 79 patients with abdominal endometriosis treated in the first Hospital of Bai Qiuen, Jilin University. To explore the related factors affecting the occurrence, clinical characteristics and prognosis of abdominal endometriosis, and to provide a reference for reducing the incidence and recurrence rate of abdominal wall endometriosis in the future. Methods: the clinical data of 79 patients with AWE after cesarean section were retrospectively analyzed and followed up by telephone. The results were analyzed by SPSS17.0 software. Results:. 1. Linear regression analysis showed that there was a positive correlation between the latent period and the onset age, the difference was statistically significant, and the latency was negatively correlated with the age of cesarean section and menstrual cycle, but the difference was not statistically significant. 2. The onset latency of 39 patients with onset age of 30 years old was significantly longer than that of 40 patients with age 鈮

本文编号：1680617