101例腹壁切口瘢痕子宮內(nèi)膜異位癥患者臨床資料的回顧性分析
發(fā)布時間：2018-08-21 10:52
【摘要】：目的：總結(jié)分析腹壁切口瘢痕子宮內(nèi)膜異位癥(Abdominal incisional endometriosis, AIEM)患者的臨床特點、診斷方法、治療及復(fù)發(fā)情況,進一步探討AIEM理想的治療及有效的預(yù)防。 方法：收集2006年1月至2013年11月在山東大學(xué)齊魯醫(yī)院婦科行手術(shù)治療的101例患者的臨床資料,病理確診為AIEM,對其發(fā)病特點、臨床表現(xiàn)、手術(shù)、藥物治療及復(fù)發(fā)情況進行回顧性分析,并采用電話隨訪。應(yīng)用SPSS18.0對數(shù)據(jù)進行統(tǒng)計分析,P0.05具有統(tǒng)計學(xué)意義。 結(jié)果：(1)發(fā)病情況：101例腹壁切口瘢痕子宮內(nèi)膜異位癥占同期子宮內(nèi)膜異位癥的2.76%(101/3654)。除了1例患者有剖宮取胎手術(shù)史,其余患者均有剖宮產(chǎn)史,發(fā)病平均年齡為32.3±4.4歲(23-45歲)。 (2)臨床特點：術(shù)后發(fā)病時間即術(shù)后出現(xiàn)臨床癥狀或體征的時間距前次剖宮產(chǎn)或剖宮取胎術(shù)的時間平均為34.8±24.9個月(1-120個月),病程即患者出現(xiàn)臨床癥狀或體征的時間到手術(shù)的時間間隔,中位值為18個月(1～126個月)。70.3%的患者具有典型的臨床癥狀,即腹壁切口瘢痕處觸及包塊,伴有周期性疼痛及體積增大,與月經(jīng)關(guān)系密切。 (3)診斷：有96例患者術(shù)前診斷為AIEM,術(shù)前確診率為95%。42例患者術(shù)前檢測血清CA125,其中28.6%(12/42)患者血清CA125高于正常,約5.74U/m1-187U/ml,中位數(shù)為24.21U/m1。84例患者術(shù)前行超聲檢查,超聲診斷符合率為79.8%(67/84)；只有76.2%(64/84)超聲提示腹壁浸潤深度。9例患者術(shù)前行MRI檢查,MIR診斷符合率為100%,均可明確包塊浸潤深度。 (4)治療：所有的患者均行腹壁子宮內(nèi)膜異位病灶切除術(shù),其中2例患者因為腹壁缺損較大,給予補片修補。13例(12.9%)患者術(shù)前行藥物治療,25例(24.8%)患者術(shù)后輔助藥物治療。 (5)復(fù)發(fā)：完成隨訪的86例患者中有9例患者復(fù)發(fā),復(fù)發(fā)率為10.5%(9/86),其中位復(fù)發(fā)時間為6個月(3-48個月)。 結(jié)論： (1)超聲檢查有助于術(shù)前診斷,MRI可幫助明確病灶浸潤深度及范圍,更有助于術(shù)前評估及術(shù)式的選擇。 (2)血清CA125的檢測對AIEM診斷價值不大。 (3)手術(shù)切除病灶是AIEM的有效方法,對于大的腹壁缺損,需借助補片修補腹壁缺損。 (4) AIEM多見于剖宮產(chǎn)術(shù)后,嚴(yán)格掌握剖宮產(chǎn)的手術(shù)指征,降低剖宮產(chǎn)率可有效預(yù)防AIEM。
[Abstract]:Objective: to summarize and analyze the clinical features, diagnosis, treatment and recurrence of abdominal incision scar endometriosis (Abdominal incisional endometriosis, AIEM) in order to explore the ideal treatment and effective prevention of AIEM. Methods: from January 2006 to November 2013, 101 patients who underwent gynecological surgery in Qilu Hospital of Shandong University were collected and diagnosed as AIEM by pathology. Drug therapy and recurrence were analyzed retrospectively and followed up by telephone. The use of SPSS18.0 for statistical analysis of data P 0.05 has statistical significance. Results: (1) 101 cases of abdominal incision scar endometriosis accounted for 2.76% (101 / 3654) of the corresponding endometriosis. Except for one patient who had a history of cesarean section, the rest had a history of cesarean section. The mean age of onset was 32.3 鹵4.4 years (23-45 years old). (2): the time of onset of postoperative symptoms or signs was 34.8 鹵24.9 months (1-120 months). That is, the interval between the time when the patient appears clinical symptoms or signs and the time between the operation and the operation, The median value was 18 months (1 ~ 126 months). 70.3% of the patients had typical clinical symptoms, I. e., abdominal incision scar touching mass, accompanied by periodic pain and volume increase. (3) diagnosis: 96 patients were diagnosed as AIEM before operation. The preoperative diagnostic rate was 95.42 patients with CA125. among them, 28.6% (12 / 42) patients' serum CA125 was higher than normal, about 5.74U / m1-187Uml, the median was pre-operation ultrasound examination in 24.21U/m1.84 patients. The coincidence rate of ultrasound diagnosis was 79.8% (67 / 84). Only 76. 2% (64 / 84) ultrasound showed the depth of abdominal wall invasion. The diagnostic coincidence rate of MRI and Mir was 100. (4) treatment: all patients underwent resection of abdominal wall endometriosis. Because of the large abdominal wall defect, 2 cases were treated with patch repair. 13 cases (12. 9%) received drug therapy before operation, 25 cases (24. 8%) received postoperative adjuvant drug therapy. (5) recurrence: 9 out of 86 patients who completed follow-up were relapsed. The recurrence rate was 10.5% (9 / 86), in which the recurrence time was 6 months (3-48 months). Conclusion: (1) Ultrasonography is helpful to the preoperative diagnosis of MRI in determining the depth and extent of lesion invasion. (2) the detection of serum CA125 is of little value in the diagnosis of AIEM. (3) operative resection of lesions is an effective method for AIEM, and is useful for large abdominal wall defects. It is necessary to repair the abdominal wall defect with patch. (4) AIEM is more common after cesarean section, so it can effectively prevent caesarean section by mastering the indications of caesarean section and reducing the rate of cesarean section.
【學(xué)位授予單位】：山東大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2014
【分類號】：R711.71
[Abstract]:Objective: to summarize and analyze the clinical features, diagnosis, treatment and recurrence of abdominal incision scar endometriosis (Abdominal incisional endometriosis, AIEM) in order to explore the ideal treatment and effective prevention of AIEM. Methods: from January 2006 to November 2013, 101 patients who underwent gynecological surgery in Qilu Hospital of Shandong University were collected and diagnosed as AIEM by pathology. Drug therapy and recurrence were analyzed retrospectively and followed up by telephone. The use of SPSS18.0 for statistical analysis of data P 0.05 has statistical significance. Results: (1) 101 cases of abdominal incision scar endometriosis accounted for 2.76% (101 / 3654) of the corresponding endometriosis. Except for one patient who had a history of cesarean section, the rest had a history of cesarean section. The mean age of onset was 32.3 鹵4.4 years (23-45 years old). (2): the time of onset of postoperative symptoms or signs was 34.8 鹵24.9 months (1-120 months). That is, the interval between the time when the patient appears clinical symptoms or signs and the time between the operation and the operation, The median value was 18 months (1 ~ 126 months). 70.3% of the patients had typical clinical symptoms, I. e., abdominal incision scar touching mass, accompanied by periodic pain and volume increase. (3) diagnosis: 96 patients were diagnosed as AIEM before operation. The preoperative diagnostic rate was 95.42 patients with CA125. among them, 28.6% (12 / 42) patients' serum CA125 was higher than normal, about 5.74U / m1-187Uml, the median was pre-operation ultrasound examination in 24.21U/m1.84 patients. The coincidence rate of ultrasound diagnosis was 79.8% (67 / 84). Only 76. 2% (64 / 84) ultrasound showed the depth of abdominal wall invasion. The diagnostic coincidence rate of MRI and Mir was 100. (4) treatment: all patients underwent resection of abdominal wall endometriosis. Because of the large abdominal wall defect, 2 cases were treated with patch repair. 13 cases (12. 9%) received drug therapy before operation, 25 cases (24. 8%) received postoperative adjuvant drug therapy. (5) recurrence: 9 out of 86 patients who completed follow-up were relapsed. The recurrence rate was 10.5% (9 / 86), in which the recurrence time was 6 months (3-48 months). Conclusion: (1) Ultrasonography is helpful to the preoperative diagnosis of MRI in determining the depth and extent of lesion invasion. (2) the detection of serum CA125 is of little value in the diagnosis of AIEM. (3) operative resection of lesions is an effective method for AIEM, and is useful for large abdominal wall defects. It is necessary to repair the abdominal wall defect with patch. (4) AIEM is more common after cesarean section, so it can effectively prevent caesarean section by mastering the indications of caesarean section and reducing the rate of cesarean section.
【學(xué)位授予單位】：山東大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2014
【分類號】：R711.71
【參考文獻】
相關(guān)期刊論文 前10條
1 王正磊;吳昊;毛定飚;;CT對腹壁子宮內(nèi)膜異位癥的診斷價值[J];臨床放射學(xué)雜志;2012年04期
2 姜忠彩;周琦;任玉Z，
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