腹壁子宫内膜异位症再次手术5例原因分析
子宫内膜异位症,腹壁；再次手术；原因分析,,子宫内膜异位症，腹壁；再次手术；原因分析,1资料和方法,2结果,3讨论,参考文献
【摘 要】 目的 探讨腹壁子宫内膜异位症(abdominal wall endometriosis,AWE)再次手术病例的临床特点。方法 回顾性总结分析1992～2005年间我院收治的101例AWE患者的临床资料，分为再次手术组5例，未再次手术组96例。分析比较2组临床特点。结果 再次手术组1例为反复发作的AWE，逐步演变为不典型子宫内膜异位症；1例患者再次手术切除的AWE位于初次手术的另一侧，此部位有经期疼痛症状，应属于遗漏；其余3例患者首次手术均距病灶边缘0.5 cm切除。再次手术组术前扪诊和B超检查AWE病灶均显著大于未再次手术组(P<0.05)，而2组手术切除病灶大小差异无显著意义(P>0.05)，可能与再次手术组的病例切除病灶外的组织较少有关。结论 手术切除AWE病灶时，应根据术前患者的症状，对可疑部位进行仔细探查，避免较小病灶的遗漏。切除病灶尽可能距病灶边缘1cm以上。对于病程长、反复发作的AWE，要警惕其恶变。【关键词】 子宫内膜异位症，腹壁；再次手术；原因分析
Clinical analysis of the cause of repeated resection for patients with abdominal wall endometriosis CHENG Ninghai,ZHU Lan,LANG Jinghe,et al.Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences,Beijing 100730,China
【Abstract】 Objective To investigate the clinical characteristics of cases undergoing repeated resection in patients with abdominal wall endometriosis (AWE).Methods Retrospective analyses were performed in 101 patients with abdominal wall endometriosis who were hospitalized in Department of Obstetrics and Gynecology of Peking Union Medical College Hospital between 1992 and 2005.According to their surgical histories, the patients were divided into two groups,repeated resection group (n=5) and nonrepeated resection group (n=96).Results In repeated resection group,there was 1 patient with repeated recurrent AWE,which had become an atypical endometriosis gradually;the lesion resected in the second surgery was on the opposite side of the first surgery in 1 patient who had a mensesrelated pain at the same site,and was supposed to be a missed diagnosis;lesions were resected with healthy tissues 0.5 cm beside their outer margin in the other three patients.The mean size of masses detected by palpations and ultrasound scan was significantly larger in repeated resection group than that in nonrepeated resection group (P<0.05).However,there was no significant difference in the excision sample dimensions between the two groups.It maybe due to the healthy tissues resected in the repeated resections that were less than those in the first surgery.Conclusion To avoid missing smaller lesions,it is important to explore the suspicious sites with caution according to patients' preoperative symptoms during the surgery.If possible,it is recommended to resect the lesions with healthy tissues 1 cm or more than it beside their outer margins.Of the longterm repeated recurrent AWE, malignant changes should be considered. ......
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