腹壁切口子宫内膜异位症65例临床分析  

Abdominal Wall Endometriosis:a Review of 65 Cases

作　　者：路光升[1] 林婉君[1] 周丽[1] 

机构地区：[1]天津市中心妇产科医院子宫内膜异位症治疗中心,300052

出　　处：《国际妇产科学杂志》2010年第4期291-293,共3页Journal of International Obstetrics and Gynecology

摘　　要：目的:探讨腹壁切口子宫内膜异位症(EMs)的临床诊断、治疗及预防。方法:回顾性分析65例腹壁切口EMs患者的临床资料。年龄23～37岁,平均(30.7±3.6)岁,均为第1胎剖宫产术后,于剖宫产术后8～36个月时出现腹部切口痛,切口瘢痕处或切口瘢痕周围腹壁肿块。入院时距剖宫产术9个月～6年,肿块约1cm×2cm～4cm×4.5cm,边界欠清晰,质韧偏实,压痛明显,不活动。23例CA125轻度升高。结果:EMs病灶部位:49例完全位于脂肪层中,13例深达腹直肌,3例达腹膜。所有患者均在硬膜外麻醉下行腹壁异位病灶切除术,对5例病灶直径>4cm的患者先给予促性腺激素释放激素激动剂(GnRHa)类药物治疗3次(每28～32d用药1次)后再手术。术后随访4～20个月,术后用药3个月,全部患者症状完全消失,无一例复发。结论:腹壁切口EMs诊断相对容易。手术是首选的治疗方法,彻底切除病灶是治疗该病的关键,术后继续用药可以避免复发。剖宫产术中采取预防措施是减少该病发生的关键。Objective ：To explore the clinical characteristics, treatment as well as prevention of abdominal wall endometriosis （AWE）. Methods： 65 cases of AWE treated at Tianjin Central Hospital of Obstetrics and Gynecology from year 2008 to 2009 were reviewed. The average age was （30.7±3.6）years, range from 23 to 37 years. All of whom un- dergone the first cesarean section presented with pain and mass of cesarean scar 8 to 36 months after surgery, were hospitalized 9 to 72 months after surgery. The size of mass was from 1 cm × 2 cm to 4 cm × 4.5 cm. The characteris- tics of mass include unclear edge, solid,hard,tenderness and inmovable. In 23 cases, CA125 were mildly elevated. Results ：All the cases were secondry to cesarean section. Of 65 cases with AWE,49 were located in adipose layer, 13 cases were as deep as rectus abdominis. Peritoneal were invaded in 3 cases. All cases were received surgical treatment while in 5 cases which lesion diameter 〉 4 cm were given gonadotropin releasing hormone agonist （GnRHa） treatment for 3 times （per 28-32 day）prior to surgery. No recurrence was observed during 4-20 month follow-up and postoperative administration for 3 months. Conclusions：AWE could be diagnosed according to its medical history, typical clinical manifestations as well as gynecological check-up. Surgical treatment is the preferred choice. A complete excision with clear margin is very important. Medicine treatment after operation can prevent recurrence. Appropriately preventive measure is important during cesarean section.

关 键 词：腹壁 子宫内膜异位症 剖宫产术 治疗 综合预防 

分 类 号：R711.71[医药卫生—妇产科学]