本文選題：剖宮產(chǎn)術(shù)　切入點(diǎn)：腹壁子宮內(nèi)膜異位癥　出處：《吉林大學(xué)》2014年碩士論文

【摘要】：背景和目的：子宮內(nèi)膜異位癥(endometriosis, EMT)，簡稱“內(nèi)異癥”，是指具有生長功能的子宮內(nèi)膜組織(腺體和間質(zhì))出現(xiàn)在子宮腔被覆內(nèi)膜及宮體肌層以外的其他部位。該病屬于良性疾病，但因其表現(xiàn)有增生、浸潤、轉(zhuǎn)移等的惡性生物學(xué)行為，故有“良性癌”之稱。該病好發(fā)于盆腔內(nèi)，以卵巢最為常見，盆腔外比較少見。腹壁子宮內(nèi)膜異位癥(abdominal wall endometriosis,AWE)是最常見的盆腔外子宮內(nèi)膜異位癥,最多見于剖宮產(chǎn)術(shù)后切口瘢痕處，，國內(nèi)研究表明,剖宮產(chǎn)術(shù)后AWE發(fā)生率0.03%~0.47%。近年來，我國剖宮產(chǎn)手術(shù)率一直居高不下,腹壁子宮內(nèi)膜異位癥的發(fā)病率也開始逐年增高，給患者的身心帶來痛苦，同時也增加了經(jīng)濟(jì)負(fù)擔(dān)。本研究回顧性分析2009年2月至2013年7月在吉林大學(xué)白求恩第一醫(yī)院收治的79例腹壁子宮內(nèi)膜異位癥患者的臨床資料，探討影響腹壁子宮內(nèi)膜異位癥的發(fā)生、臨床特點(diǎn)以及預(yù)后的相關(guān)因素，希望為今后減少腹壁子宮內(nèi)膜異位癥的發(fā)病率及術(shù)后復(fù)發(fā)率提供參考。 方法：對已行手術(shù)切除病灶并有術(shù)后病理明確診斷的79例剖宮產(chǎn)術(shù)后AWE患者的臨床資料進(jìn)行回顧性分析并電話隨訪，收錄結(jié)果經(jīng)SPSS17.0軟件進(jìn)行統(tǒng)計學(xué)分析。 結(jié)果： 1.線性回歸分析提示該病潛伏期與發(fā)病年齡呈正相關(guān)(r=0.326，P=0.003)，其差異有統(tǒng)計學(xué)意義；潛伏期與剖宮產(chǎn)年齡、月經(jīng)周期呈負(fù)相關(guān)，但其差異均無統(tǒng)計學(xué)意義。 2.發(fā)病年齡30歲(39例)的研究對象其發(fā)病潛伏期與年齡≤30歲者(40例)相比，時間明顯延長，差異具有統(tǒng)計學(xué)意義(t=-2.217,P=0.03)；月經(jīng)周期≥28天的研究對象（62例）其發(fā)病潛伏期較周期＜28天者（17例）時間長，影響差異具有統(tǒng)計學(xué)意義（t=-2.639，P=0.01）；而剖宮產(chǎn)年齡＞30歲（9例）的患者與年齡≤30歲（70例）的患者對發(fā)病潛伏期影響無顯著性差異（t=1.206，P=0.208）。 3.79例患者均于術(shù)前診斷為腹壁子宮內(nèi)膜異位癥，治療方法為行手術(shù)切除病灶，術(shù)中切緣距病灶邊緣0.5-1.0cm，術(shù)后追加藥物輔助治療的患者19例。 4.79例研究對象中僅有63例成功隨訪，其中20.6%（13/63）再次出現(xiàn)瘢痕處疼痛，有2例研究對象切口周圍可觸及明顯包塊，與月經(jīng)周期有關(guān)，臨床診斷為AWE復(fù)發(fā)。13例復(fù)發(fā)患者中：有3例患者術(shù)中病灶＞3cm；有9例為橫行剖宮產(chǎn)切口；有9例術(shù)后未追加藥物輔助治療。 結(jié)論： 1.嚴(yán)格控制剖宮產(chǎn)指征，降低剖宮產(chǎn)率是降低AWE發(fā)病率的關(guān)鍵。 2.腹壁子宮內(nèi)膜異位癥患者的發(fā)病年齡及月經(jīng)周期是該病潛伏期的影響因素，而患者的剖宮產(chǎn)年齡與該病無明顯相關(guān)性。 3.腹壁橫切口的AWE患者其發(fā)病率及復(fù)發(fā)率均高于縱切口，支持異位內(nèi)膜種植學(xué)說，故剖宮產(chǎn)切口的選擇及其術(shù)中切口的保護(hù)成為降低AWE發(fā)病率和復(fù)發(fā)率的另一重要因素。
[Abstract]:Background & AIM: endometriosis endometriosis (EMTA) refers to the presence of endometrial tissues (glands and stroma) with growth function in other parts of the uterine cavity other than the endometrium and the myometrium of the uterine body. The disease is a benign disease. However, it is known as "benign cancer" because of its malignant biological behavior such as hyperplasia, infiltration, metastasis, etc. The disease is common in the pelvic cavity, especially in the ovary. Endometriosis of abdominal wall wall endometriosis is the most common pelvic endometriosis, most commonly seen in scar of incision after cesarean section. Domestic studies show that the incidence of AWE after cesarean section is 0.03 and 0.47. In recent years, The rate of cesarean section is always high in our country, and the incidence of endometriosis in the abdominal wall is increasing year by year, which brings pain to the patients' body and mind. From February 2009 to July 2013, we retrospectively analyzed the clinical data of 79 patients with abdominal endometriosis treated in the first Hospital of Bai Qiuen, Jilin University. To explore the related factors affecting the occurrence, clinical characteristics and prognosis of abdominal endometriosis, and to provide a reference for reducing the incidence and recurrence rate of abdominal wall endometriosis in the future. Methods: the clinical data of 79 patients with AWE after cesarean section were retrospectively analyzed and followed up by telephone. The results were analyzed by SPSS17.0 software. Results:. 1. Linear regression analysis showed that there was a positive correlation between the latent period and the onset age, the difference was statistically significant, and the latency was negatively correlated with the age of cesarean section and menstrual cycle, but the difference was not statistically significant. 2. The onset latency of 39 patients with onset age of 30 years old was significantly longer than that of 40 patients with age 鈮

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