腹壁内异症151例临床分析

摘要

目的 探讨腹壁内异症(AWE)的临床特点.方法 回顾性分析复旦大学附属妇产科医院2003年1月至2010年12月间收治的166例AWE患者的临床资料,其中151例完成随访,随访时间16 ～97个月.结果(1)发病情况:AWE占同期内异症的1.96％(166/8469).随访资料完整的151例AWE患者均有剖宫产史,术后发病距前次手术时间为24个月(3～192个月),其长短与前次剖宫产相关因素(剖宫产时年龄、切口位置、分娩孕周、产后哺乳时间、产后月经恢复时间和产后是否避孕)均无相关性(P＞0.05),与AWE病灶大小也无相关性(P＞0.05).AWE患者的病程为26个月(2～ 168个月),病程长短与术后发病至前次手术时间呈负相关(r=-0.267,P＜0.05),与AWE病灶大小呈正相关[病灶最大直径≥3 cm者(101例),病程明显长于病灶最大直径＜3 cm者(50例),r=0.326,P＜0.05].(2)辅助检查:术前超声检查确诊AWE 147例(97.4％,147/151),超声检查病灶中位最大直径为20 mm,明显小于术中探查的病灶中位最大直径35 mm,差异有统计学意义(P＜0.05),仅有26.5％(40/151)的患者术前超声可提示病灶侵犯的深度.(3)疗效及其影响因素:所有患者均手术切除AWE病灶,其中34例(22.5％,34/151)患者术前药物治疗3～9个月,57例患者(37.7％,57/151)术后药物治疗.AWE病灶最大直径≥3 cm者的复发率为3.1％(3/96)显著低于AWE病灶最大直径＜3 cm者的17.8％(8/45),差异也有统计学意义(P＜0.05).术后药物治疗者的复发率(3.8％,2/53)显著低于未用药物者(10.2％,9/88),差异也有统计学意义(P＜0.05).(4)症状缓解及复发情况:术后症状缓解率为93.4％(141/151),复发率为7.8％(11/141),平均复发时间为(20±16)个月.结论 手术是治疗AWE的主要方法,AWE病灶大小及术后用药与否是影响复发的主要因素.%Objective To investigate clinicopathological features of abdominal wall endometriosis(AWE).Methods A retrospective study was conducted on 151 consecutive AWE patients undergoing treatment in Affiliated Obstetrics and Gynecology Hospital,Fudan University from January 2003 to December 2010.The period of following up was at range of 16 to 97 months.Results(1)The incidence of AWE was 1.96％(166/8469).All 151 AWE cases followed up had previous cesarean sections.The period between the previous cesarean section(CS)and the onset of symptoms of AWE was 24 months(3-192 months).However,the latency was not associated with the age at CS,incision site,gestational week at CS,duration of lactation,postpartum menstruation recovery,the choice of contraceptives and size of AWE(P ＞ 0.05).The duration of disease,defined to be the time interval between the onset of symptoms and surgery,was 26 months(2-168 months),which was negatively correlated with the latent period(r =-0.267,P ＜ 0.05)and was positively with size of AWE(patients with large-scar endometrioma with diameter of lesions ≥ 3 cm had longer disease duration than those with small-scar endometriomas ＜ 3 cm,r =0.326,P ＜ 0.05).(2)The rate of pre-operational ultrasonography detection was 97.4％(147/151).The lesion size detected by pre-operative ultrasonography was significantly smaller than that measured intraoperatively by palpation (20 mm versus 35 mm,P ＜ 0.05).Moreover,only 26.5％(40/151)of AWE patients were found to have deep infiltration by pre-operative ultrasonography.(3)All patients were managed by surgical treatment to completely excise lesions on the abdominal wall.Of all 34 patients(22.5％,34/151)took medicine preoperatively while 57 patients(37.7％,57/151)taking medicine post-operatively.The rate of recurrence was 3.1％(3/96)of cases with lesions ≥3 cm,which was significantly lower than 17.8％(8/45)in cases with lesion ＜ 3 cm(P ＜ 0.05).(4)After surgery,the symptoms were found to be relieved in 93.4％(141/ 151)of patients.The recurrence rate was 7.8％(11/141)while the average recurrent time was(20 ± 16)months.Conclusion Surgery is the main management on AWE.The risk factors associated with recurrence were size of lesion and postoperative medication.