摘要
目的:探讨腹壁子宫内膜异位症(AWE)的临床特征、分型、治疗及预后。方法:回顾分析2010年1月1日至2019年12月31日就诊于山东大学附属省立医院的241例AWE患者的临床资料。并按病灶浸润深浅分为皮下型、鞘膜型及腹膜型,按是否合并盆腔子宫内膜异位症分为单纯型及复杂型,按病灶个数分为单发型及多发型,比较各组的临床特点。结果:241例AWE患者的平均发病年龄(30.6±4.6)岁。98.8%(238例)既往有剖宫产手术史。93.4%患者就诊时可触及明显腹壁包块,94.6%患者因刀口处或周围疼痛就诊,其中82.9%疼痛与月经周期有明显相关性。208例(86.7%)AWE患者术前做了超声检查,均提示明显包块。病灶大小与病程、手术时间、术中出血量、是否放置补片、单纯型和复杂型、皮下型鞘膜型和腹膜型及住院天数存在正相关,差异有统计学意义(P<0.05)。皮下型、鞘膜型和腹膜型的血清CA125水平相比,差异有统计学意义(P<0.05);单纯型和复杂型血清CA125水平相比,差异有统计学意义(P<0.05)。皮下型、鞘膜型和腹膜型三型的病灶大小及术中出血量相比,差异有统计学意义(P<0.05);病灶直径越大,侵及深度越深,差异有统计学意义(P<0.05)。AWE患者的复发率8.8%,病灶个数为AWE复发的独立危险因素(P=0.033),与单发型相比,多发型AWE患者的复发风险远高于单发型(HR=3.152,95%CI为1.095~9.078)。术后药物治疗的26例患者均未复发。结论:AWE应做到早发现、早诊断、早治疗,一旦确诊应立即手术治疗。超声检查和血清CA125对其诊断和分型有意义。多发型AWE术后易复发。术后药物治疗对预防复发有价值。
Objective:To investigate the clinical characteristics,type,treatment and prognosis of abdominal wall endometriosis(AWE).Methods:The clinical datas of 241 patients with abdominal wall endometriosis who visited Shandong Provincial Hospital from January 1st 2010 to December 31st.2019 were retrospectively analyzed.According to the depth of lesion infiltration,it was divided into subcutaneous type,sheath type and peritoneal type,simple type and complex type according to whether there was complicated pelvic endometriosis,and single type and multiple type according to the number of lesions.Compare the clinical characteristics of each group.Results:The average age of onset of 241 AWE patients was(30.6±4.6)years old.98.8%(238 cases)had a history of cesarean section operation.Significant abdominal wall mass was palpable in 93.4%of the patients,and 94.6%of the patients were treated for pain at or around the incision,of which 82.9%had significant correlation with the menstrual cycle.208 cases(86.7%)of AWE patients underwent preoperative ultrasound examination,and all showed obvious mass.The lesion size was positively correlated with the course of disease,perative time,intraoperative blood loss,whether patch was placed,simple and complex type,subcutaneous sheath type and peritoneal type,and length of stay,with statistically significant differences(P<0.05).Compared with the CA125 of subcutaneous type,sheath type and peritoneal type,the difference was statistically significant(P<0.05).The difference of CA125 between the simple type and complex type was statistically significant(P<0.05).The difference in lesion size and intraoperative blood loss between subcutaneous type,sheath type and peritoneal type was statistically significant(P<0.05).The larger the diameter of the lesion,the deeper the invasion depth,the difference was statistically significant(P<0.05).The recurrence rate was 8.8%,and the number of lesions was an independent risk factor for the recurrence of AWE(P=0.033).The risk of recurrence was significantly higher in patients with multiple AWE than in patients with single AWE(HR=3.152,95%CI:1.095~9.078).No recurrence was found in 26 patients treated with postoperative medication.Conclusion:AWE should be given early detection,early diagnosis and early treatment,and should be operated immediately once confirmed.Ultrasonography and serum CA125 are useful for diagnosis and typing.Multiple hair AWE is prone to recurrence after surgery.Postoperative drug therapy is of grate value in preventing recurrence.
作者
李瑞
师少乐
张辉
李春艳
李明江
Li Rui;Shi Shaole;Zhang Hui(Department of Gynecology,Provincial Hospital Affiliated to Shandong University,Jinan 250021)
出处
《现代妇产科进展》
CSCD
北大核心
2021年第7期508-513,519,共7页
Progress in Obstetrics and Gynecology
基金
国家重点研发计划(No:2017YEC1001200)
国家自然科学基金资助项目(No:81671433)。
