496例腹壁子宫内膜异位症临床分析

发布时间：2019-02-12 20:52

【摘要】：目的:探讨腹壁子宫内膜异位症(AWE)的相关临床特征、治疗及预后的影响因素。方法:回顾分析2007年1月1日至2016年12月31日因AWE就诊于复旦大学附属妇产科医院的496例患者的临床病例资料,包括患者的一般情况、临床表现、手术情况及预后情况。结果:496例AWE患者的平均年龄(31.4±4)岁。既往剖宫产史495例,子宫肌瘤手术史1例。病灶浸润深度至筋膜层(49.6%),至肌层、腹膜及脂肪层分别占21.2%、14.5%及14.3%。94.6%的AWE患者有切口处疼痛,90.7%可触及包块。术前均行B超检查,均发现包块,包块直径(26.06±12.2)mm。患者均行手术治疗,20.1%行补片修补;147例患者术后辅助药物治疗。术后随访3个月~7年,421随访患者中,21例复发,总体复发率4.9%;多个病灶患者的复发率(11.6%)明显高于单个病灶患者(3.9%),差异有统计学意义(P0.05)。复发患者的平均年龄小于未复发患者,差异有统计学意义(P0.05),但包块大小及其浸润深度对复发无显著影响。术后辅助药物治疗患者的复发率[3.6%(5/138)]低于未药物治疗者[5.7%(16/283)],但差异无统计学意义(P0.05)。结论:AWE的主要原因是剖宫产,属于医源性疾病。发病年龄早及多个病灶的患者术后较易复发。手术治疗为最主要的治疗方式,术后辅助药物治疗有助于减少复发。
[Abstract]:Objective: to investigate the clinical features, treatment and prognostic factors of abdominal wall endometriosis (AWE). Methods: the clinical data of 496 patients admitted to Fudan University Obstetrics and Gynecology Hospital for AWE from January 1, 2007 to December 31, 2016 were retrospectively analyzed, including the general situation, clinical manifestations, surgical conditions and prognosis of the patients. Results: the average age of 496 patients with AWE was (31.4 卤4) years old. There were 495 cases of cesarean section and 1 case of hysteromyoma operation. Invasion depth to fascia layer (49.6%), to myometrium, peritoneal layer and fat layer accounted for 21.22.5% and 14.3.94.6% of AWE patients had incision pain, 90.7% of them could touch mass. All the patients were examined by B-ultrasound before operation. The mass was found and the diameter of the mass was (26.06 卤12.2) mm.. All patients were treated by surgery, 20.1% were treated with patch repair, 147 patients were treated with adjuvant drugs after operation. Among 421 patients followed up for 3 months to 7 years, 21 cases recurred and the overall recurrence rate was 4.9%. The recurrence rate of patients with multiple lesions (11.6%) was significantly higher than that of patients with single focus (3.9%), and the difference was statistically significant (P0.05). The average age of recurrent patients was smaller than that of non-recurrent patients (P0.05), but the size of mass and the depth of infiltration had no significant effect on recurrence. The recurrence rate of postoperative adjuvant drug therapy patients [3.6% (5 / 138)] was lower than that of untreated patients [5.7% (16 / 283)], but the difference was not statistically significant (P0.05). Conclusion: the main cause of AWE is cesarean section, which belongs to iatrogenic diseases. Patients with early onset and multiple lesions were more likely to recur after operation. Surgical treatment is the most important treatment, postoperative adjuvant drug therapy can help reduce recurrence.
【作者单位】：复旦大学附属妇产科医院妇科;新疆医科大学第一附属医院妇科;
【分类号】：R711.71

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