Clinical analysis of abdominal wall endometriosis in 101 cases

摘要

Objective: To review the clinical characteristics, treatment and prognoses of abdominal wall endometriosis(AWE).Methods: A retrospective study of 101 cases of AWE from 1992 to 2005 at Obstetric and Gynecologic Department of Peking Union Medical College Hospital was performed. Ninety-eight patients had a history of caesarean section. The mean age of the patients was (33.3±4.8) years and the average size of the mass was 1.5 cm. Abdominal wall mass associated pain during the menstrual cycle was noticed in 89.8% of the patients. The occurrence of AWE after caesarean section was 0.05% at our hospital. In patients without pelvic endometriosis or adenomyosis, 20.5% were presented with high CA125 >35 U/ml and the highest one was 93.4 U/ml. 92.1% of patients were diagnosed before surgery. 4 patients were administrated first in General Surgical Department with painless abdominal mass. Medication was adopted in 16 cases pre-operatively and 14 cases post-operatively.Results: The mean size of the resected mass was 4.2 cm, significantly larger than the estimation with palpation or ultrasonography, which was 0.8-1.2 cm (P=0.006, P<0.001). Pelvic endometriosis or adenomyosis was detected during the operation in 13 patients. One patient was diagnosed as atypical endometriosis by pathological examination in the beginning but transformed to be sarcoma finally. Ten patients recurred after surgery. 2 of them received medication and 5 of them received second operation.Conclusions: Ultrasonography can be used to evaluate the size of the mass and the infiltrative scope pre-operation. The serum CA125 is not specific for diagnosis of AWE. Complete eradication of the lesion with at least 1 cm beyond the edge of the mass is recommended as the primary treatment. Eradication should be considered also in recurrent cases. It may transform to malignant lesions after multiple recurrence.