作　　者： (张璐）; (赵骏达）; (张绍芬）; (邹世恩）;

机构地区： 复旦大学附属妇产科医院妇科,上海200011

出　　处： 《现代妇产科进展》 2017年第8期599-602,共4页

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(P<0.05)。复发患者的平均年龄小于未复发患者,差异有统计学意义(P<0.05),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(P>0.05)。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。 Objective： To investigate the clinical characters,treatment and prognosis of abdominal wall endometriosis（ AWE）.Methods： A retrospective study was conducted on women diagnosed with AWE at Obstetrics Gynecology Hospital of Fudan University from Jan.2007 to Dec.2016. Data on Patient age,previous operations,symptoms,time-gap between last surgery and onset of symptoms,mass location,size,diagnoses,treatment and recurrence were analyzed.Results： A total of 496 patients were analyzed in the present cross-sectional study（ mean age31.4±4 years）.All the patients had cesarean section history except for one who had a history of hysteromyomectomy.The primary clinical presentations were abdominal pain（ 94.6%） and masses（ 90.7%）.All the patients received surgical therapy,of which 20.1% required mesh for fascial closure.29.6%（ 147 patients） received medical therapy post-operatively. The total recurrence rate was 4.9%（ 21/421）,and the recurrence rate of patients with multiple foci was significantly higher than those with single focus（ 11.6% vs 3.9%,P〈0.05）.Age and number of focus were considered to have a great influence on the development of recurrence while size and location of focus did not. The recurrence of patients who took medical therapy post-operatively was slightly lower than those who did not（ 3.6% vs 5.7%,P〈0.05）.Conclusion： Cesarean section is closely related with the development of AWE in China. Younger age and multiple foci may play an important role in the recurrence of AWE. Surgery is the primary treatment for AWE,while postoperative treatment has no significant effect on reducing the recurrence rate of AWE.

关 键 词： 腹壁子宫内膜异位症 剖宫产 子宫内膜异位症