剖宫产疤痕子宫内膜异位症临床研究  

A Clinical Study of Cesarean Scar Endometriosis

作　　者：张平[1] 孙亚兵[1] 张晨[1] 杨叶平 张琳娜 许泓[1] Zhang Ping;Sun Yabing;Zhang Chen;Yang Yeping;Zhang Linna;Xu Hong(The International Peace Maternity and Child Health Hospital,School of Medicine,Shanghai Jiao Tong University,Shanghai 200030,China)

机构地区：[1]上海交通大学医学院附属国际和平妇幼保健院,上海200030

出　　处：《南京师大学报（自然科学版）》2018年第1期97-101,107,共6页Journal of Nanjing Normal University(Natural Science Edition)

基　　金：上海市自然科学基金(15ZR1444100;17411972800)

摘　　要：剖宫产疤痕子宫内膜异位症是一种少见的医源性疾病,本研究旨在探讨其临床特征和预防方法.回顾分析本院2007年1月至2016年12月剖宫产疤痕子宫内膜异位症患者的临床资料,共有169例剖宫产疤痕子宫内膜异位症患者被纳入研究.患者平均年龄(32.0±3.9)岁,产次1~2次.潜伏期平均为(31.4±23.7)月,与患者年龄、产次等基本特征无明显相关性.80.5%的患者既往剖宫产为Pfannenstiel切口,19.5%的患者为正中纵形切口.统计学分析发现,Pfannenstiel切口发生子宫内膜异位症的潜伏期显著低于正中纵形切口(24.0 vs 36.0,P=0.005),并且多发性子宫内膜腺瘤患者潜伏期显著低于单个腺瘤患者(12.0 vs 24.0,P=0.034).子宫内膜腺瘤在剖宫产疤痕的两端更常见,在Pfannenstiel切口,83.4%的腺瘤位于两端;在正中纵形切口,84.8%的腺瘤位于两端.本研究提示剖宫产Pfannenstiel切口发生子宫内膜异位症的风险可能高于正中纵形切口,但仍需大样本前瞻性研究的验证.在剖宫产结束时彻底冲洗切口,尤其是脂肪层和筋膜层的两端对于预防剖宫产疤痕子宫内膜异位症十分重要.Abdominal wall endometriosis after cesarean section,also named cesarean scar endometriosis(CSE),is an uncommon iatrogenic disease.The aim of this study is to identify the clinical features of CSE and recommend precautionary measures.A retrospective study was undertaken for CSE patients treated surgically at a university hospital in China between January 2007 and December 2016.The final sample included 169 CSE cases.The mean age of the patients was(32.0±3.9)years,and parity ranged from 1 to 2.The latent period of the CSE was(31.4±23.7)months.No significant latent period difference was identified based on patients'baseline characteristics.A majority(80.5%,n=136)of the patients had Pfannenstiel incisions,and a minority(19.5%,n=33)had vertical midline incisions.The latent period of the CSE in Pfannenstiel incision was significantly shorter than that in vertical midline incision(24.0 vs 36.0,P=0.005),and the latent period in patients with multiple endometriomas was significantly shorter than that in patients with a single endometrioma(12.0 vs 24.0,P=0.034).Lesions of scar endometrioma were more common in both corner sites:121/145(83.4%)in Pfannenstiel incision scars and 28/33(84.8%)in vertical midline incision scars.Although further studies are needed,the findings of this study suggest that Pfannenstiel incision carries a higher risk of CSE than vertical midline incision.Thorough cleaning at the conclusion of CS,particularly both corner sites of the adipose layer and fascia layer,are strongly recommended for CSE prevention.

关 键 词：腹壁子宫内膜异位症 剖宫产术 剖宫产疤痕子宫内膜异位症 Pfannenstiel切口 

分 类 号：R713.1[医药卫生—妇产科学]