101例腹壁切口瘢痕子宫内膜异位症患者临床资料的回顾性分析
发布时间：2018-08-21 10:52
【摘要】：目的：总结分析腹壁切口瘢痕子宫内膜异位症(Abdominal incisional endometriosis, AIEM)患者的临床特点、诊断方法、治疗及复发情况,进一步探讨AIEM理想的治疗及有效的预防。 方法：收集2006年1月至2013年11月在山东大学齐鲁医院妇科行手术治疗的101例患者的临床资料,病理确诊为AIEM,对其发病特点、临床表现、手术、药物治疗及复发情况进行回顾性分析,并采用电话随访。应用SPSS18.0对数据进行统计分析,P0.05具有统计学意义。 结果：(1)发病情况：101例腹壁切口瘢痕子宫内膜异位症占同期子宫内膜异位症的2.76%(101/3654)。除了1例患者有剖宫取胎手术史,其余患者均有剖宫产史,发病平均年龄为32.3±4.4岁(23-45岁)。 (2)临床特点：术后发病时间即术后出现临床症状或体征的时间距前次剖宫产或剖宫取胎术的时间平均为34.8±24.9个月(1-120个月),病程即患者出现临床症状或体征的时间到手术的时间间隔,中位值为18个月(1～126个月)。70.3%的患者具有典型的临床症状,即腹壁切口瘢痕处触及包块,伴有周期性疼痛及体积增大,与月经关系密切。 (3)诊断：有96例患者术前诊断为AIEM,术前确诊率为95%。42例患者术前检测血清CA125,其中28.6%(12/42)患者血清CA125高于正常,约5.74U/m1-187U/ml,中位数为24.21U/m1。84例患者术前行超声检查,超声诊断符合率为79.8%(67/84)；只有76.2%(64/84)超声提示腹壁浸润深度。9例患者术前行MRI检查,MIR诊断符合率为100%,均可明确包块浸润深度。 (4)治疗：所有的患者均行腹壁子宫内膜异位病灶切除术,其中2例患者因为腹壁缺损较大,给予补片修补。13例(12.9%)患者术前行药物治疗,25例(24.8%)患者术后辅助药物治疗。 (5)复发：完成随访的86例患者中有9例患者复发,复发率为10.5%(9/86),其中位复发时间为6个月(3-48个月)。 结论： (1)超声检查有助于术前诊断,MRI可帮助明确病灶浸润深度及范围,更有助于术前评估及术式的选择。 (2)血清CA125的检测对AIEM诊断价值不大。 (3)手术切除病灶是AIEM的有效方法,对于大的腹壁缺损,需借助补片修补腹壁缺损。 (4) AIEM多见于剖宫产术后,严格掌握剖宫产的手术指征,降低剖宫产率可有效预防AIEM。
[Abstract]:Objective: to summarize and analyze the clinical features, diagnosis, treatment and recurrence of abdominal incision scar endometriosis (Abdominal incisional endometriosis, AIEM) in order to explore the ideal treatment and effective prevention of AIEM. Methods: from January 2006 to November 2013, 101 patients who underwent gynecological surgery in Qilu Hospital of Shandong University were collected and diagnosed as AIEM by pathology. Drug therapy and recurrence were analyzed retrospectively and followed up by telephone. The use of SPSS18.0 for statistical analysis of data P 0.05 has statistical significance. Results: (1) 101 cases of abdominal incision scar endometriosis accounted for 2.76% (101 / 3654) of the corresponding endometriosis. Except for one patient who had a history of cesarean section, the rest had a history of cesarean section. The mean age of onset was 32.3 卤4.4 years (23-45 years old). (2): the time of onset of postoperative symptoms or signs was 34.8 卤24.9 months (1-120 months). That is, the interval between the time when the patient appears clinical symptoms or signs and the time between the operation and the operation, The median value was 18 months (1 ~ 126 months). 70.3% of the patients had typical clinical symptoms, I. e., abdominal incision scar touching mass, accompanied by periodic pain and volume increase. (3) diagnosis: 96 patients were diagnosed as AIEM before operation. The preoperative diagnostic rate was 95.42 patients with CA125. among them, 28.6% (12 / 42) patients' serum CA125 was higher than normal, about 5.74U / m1-187Uml, the median was pre-operation ultrasound examination in 24.21U/m1.84 patients. The coincidence rate of ultrasound diagnosis was 79.8% (67 / 84). Only 76. 2% (64 / 84) ultrasound showed the depth of abdominal wall invasion. The diagnostic coincidence rate of MRI and Mir was 100. (4) treatment: all patients underwent resection of abdominal wall endometriosis. Because of the large abdominal wall defect, 2 cases were treated with patch repair. 13 cases (12. 9%) received drug therapy before operation, 25 cases (24. 8%) received postoperative adjuvant drug therapy. (5) recurrence: 9 out of 86 patients who completed follow-up were relapsed. The recurrence rate was 10.5% (9 / 86), in which the recurrence time was 6 months (3-48 months). Conclusion: (1) Ultrasonography is helpful to the preoperative diagnosis of MRI in determining the depth and extent of lesion invasion. (2) the detection of serum CA125 is of little value in the diagnosis of AIEM. (3) operative resection of lesions is an effective method for AIEM, and is useful for large abdominal wall defects. It is necessary to repair the abdominal wall defect with patch. (4) AIEM is more common after cesarean section, so it can effectively prevent caesarean section by mastering the indications of caesarean section and reducing the rate of cesarean section.
【学位授予单位】：山东大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R711.71
[Abstract]:Objective: to summarize and analyze the clinical features, diagnosis, treatment and recurrence of abdominal incision scar endometriosis (Abdominal incisional endometriosis, AIEM) in order to explore the ideal treatment and effective prevention of AIEM. Methods: from January 2006 to November 2013, 101 patients who underwent gynecological surgery in Qilu Hospital of Shandong University were collected and diagnosed as AIEM by pathology. Drug therapy and recurrence were analyzed retrospectively and followed up by telephone. The use of SPSS18.0 for statistical analysis of data P 0.05 has statistical significance. Results: (1) 101 cases of abdominal incision scar endometriosis accounted for 2.76% (101 / 3654) of the corresponding endometriosis. Except for one patient who had a history of cesarean section, the rest had a history of cesarean section. The mean age of onset was 32.3 卤4.4 years (23-45 years old). (2): the time of onset of postoperative symptoms or signs was 34.8 卤24.9 months (1-120 months). That is, the interval between the time when the patient appears clinical symptoms or signs and the time between the operation and the operation, The median value was 18 months (1 ~ 126 months). 70.3% of the patients had typical clinical symptoms, I. e., abdominal incision scar touching mass, accompanied by periodic pain and volume increase. (3) diagnosis: 96 patients were diagnosed as AIEM before operation. The preoperative diagnostic rate was 95.42 patients with CA125. among them, 28.6% (12 / 42) patients' serum CA125 was higher than normal, about 5.74U / m1-187Uml, the median was pre-operation ultrasound examination in 24.21U/m1.84 patients. The coincidence rate of ultrasound diagnosis was 79.8% (67 / 84). Only 76. 2% (64 / 84) ultrasound showed the depth of abdominal wall invasion. The diagnostic coincidence rate of MRI and Mir was 100. (4) treatment: all patients underwent resection of abdominal wall endometriosis. Because of the large abdominal wall defect, 2 cases were treated with patch repair. 13 cases (12. 9%) received drug therapy before operation, 25 cases (24. 8%) received postoperative adjuvant drug therapy. (5) recurrence: 9 out of 86 patients who completed follow-up were relapsed. The recurrence rate was 10.5% (9 / 86), in which the recurrence time was 6 months (3-48 months). Conclusion: (1) Ultrasonography is helpful to the preoperative diagnosis of MRI in determining the depth and extent of lesion invasion. (2) the detection of serum CA125 is of little value in the diagnosis of AIEM. (3) operative resection of lesions is an effective method for AIEM, and is useful for large abdominal wall defects. It is necessary to repair the abdominal wall defect with patch. (4) AIEM is more common after cesarean section, so it can effectively prevent caesarean section by mastering the indications of caesarean section and reducing the rate of cesarean section.
【学位授予单位】：山东大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R711.71
【参考文献】
相关期刊论文 前10条
1 王正磊;吴昊;毛定飚;;CT对腹壁子宫内膜异位症的诊断价值[J];临床放射学杂志;2012年04期
2 姜忠彩;周琦;任玉Z，
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