生殖医学杂志

目的探讨腹壁子宫内膜异位症(AWE)的临床特点、治疗方法和预后。方法回顾性分析1992~2005年本院收治的101例手术病例。其中足月剖宫产史98例,就诊年龄(33.3±4.8)岁,就诊时距剖宫产(72.0±44.7)月,89.8%患者有周期性肿物疼痛。结果剖宫产后发生率0.05%,8,061例盆腔子宫内膜异位症术后无AWE发生。20.5%患者CA125>35 U/ml,92.1%病例术前诊断AWE。术前16例、术后14例接受药物治疗。手术切除病灶平均4.2 cm,显著大于术前扪诊和超声测量0.8¹.2 cm(P<0.01)。1例病理为不典型子宫内膜异位症,最终恶变为癌肉瘤。术后复发10例,5例再次手术。结论B超用于术前测量大小和确定病灶的浸润范围,血清CA125不敏感,尚不能预测预后,治疗首选手术,范围应达病灶外1 cm,复发后可再次手术,多次复发者警惕恶变。

Objective: To investigate the clinical characteristics,treatments and prognoses of abdominal wall endometriosis.Methods: A retrospective analysis was performed on 101 patients with abdominal wall endometriosis(AWE) hospitalized in Obstetric & Gynecologic Department of Peking Union Medical College Hospital between 1992 and 2005.Results: Of 101 patients with AWE,98 had a history of caesarean section,with an abdominal wall mass(average 1.5 cm) at the first visit.Their mean age was(33.3±4.8) years.89.8% of patients had a menses-related cyclically painful mass.The incidence of abdominal wall endometriosis in the patients undergoing caesarean delivery in our hospital was 0.05%.Among 8,061 patients with endometriosis of pelvis treated by surgery,no AWE case was observed.CA125>35 U/ml was recorded in 20.5% of patients.AWE was diagnosed before surgery in 92.1% of patients.Pre-operational medication was adopted in 16 cases,and 14 patients received medication after surgery.The mean size of the lesions resected in the surgeries was 4.2 cm,significantly larger than that measured by pre-operational palpation or ultrasonography(about 0.8～1.2 cm)(P<0.01).Ten patients relapsed after surgery,and 5 of them received resection after relapse.Atypical endometriosis was pathologically confirmed in 1 patient.This patient relapsed after surgery and was finally diagnosed as sarcomatous transformation.Conclusions: B-ultrasonography can be used to measure the size of mass and define the infiltrative extent.The pre-surgical serum CA125 evaluation was not sensitive enough for the diagnosis and could not be used to predict the relapse.Surgical excision of AWE with at least 1 cm outside the edge of AWE,combined with pre-surgical and post-surgical medication,should be the first choice.Repeated resection can be considered in recurrent patients.Possibility of malignant transformation of AWE should be considered in the patients with repeatedly relapse.