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目的:探讨腹壁子宫内膜异位症(abdominal wall endometriosis,AWE)的临床特点和治疗方法。方法:对我院1997-2006年收治的20例AWE患者的临床资料进行回顾性分析,术后随访1～60个月。结果:AWE占同期子宫内膜异位症的1.48%,大多数继发于剖宫产后,本组20例中19例继发于剖宫产术后。根据病史特点以及B超检查结果,术前诊断符合率95%(19/20)。20例术前超声均提示切口深方低至无回声暗区。6例术前检测CA125,均在正常范围。20例均行手术治疗,其中4例术前曾接受药物治疗,效果不佳。8例术后接受药物治疗。术后随访1～60个月,复发1例。结论:随着剖宫产率的上升,AWE逐年增多。AWE根据典型的病史特点常可明确诊断。超声用于术前评估和辅助定位,血清CA125不敏感。治疗首选手术,单纯药物治疗仅能使症状得到暂时的缓解,停药后很快复发,手术范围应达病灶周围0.5～1cm正常组织。术中病灶清除彻底,术后不用辅助药物治疗,复发者可再次手术。
Objective: To investigate the clinical features and treatment of abdominal wall endometriosis (AWE). Methods: The clinical data of 20 patients with AWE admitted to our hospital from 1997 to 2006 were analyzed retrospectively. The patients were followed up for 1 to 60 months. Results: AWE accounted for 1.48% of the same period of endometriosis, most of the secondary to caesarean section, the group of 20 cases in 19 cases secondary to cesarean section. According to the characteristics of history and B-ultrasound, the coincidence rate of preoperative diagnosis was 95% (19/20). 20 cases of preoperative ultrasound are prompted deep incision as low as no echo dark area. 6 cases of preoperative detection of CA125, are in the normal range. Twenty patients underwent surgery, of whom 4 had preoperative medication and had poor outcomes. Eight patients received medication after surgery. Follow-up 1 to 60 months after surgery, 1 case of recurrence. Conclusion: With the increase of cesarean section rate, AWE is increasing year by year. AWE can often make a definite diagnosis based on typical medical history. Ultrasound for preoperative assessment and auxiliary positioning, serum CA125 insensitive. The treatment of choice for surgery, drug therapy alone can only temporarily alleviate the symptoms, relapse soon after stopping, the surgical range should reach 0.5 ~ 1cm normal tissue around the lesion. Intraoperative clear lesions completely without postoperative adjuvant drug treatment, relapse surgery can be repeated.