134例剖宫产术后腹壁子宫内膜异位症相关临床因素分析

Analysis of Clinical Factors Related to Abdominal Endometriosis after Cesarean Section in 134 Cases

摘要: 目的：研究剖宫产术后腹壁子宫内膜异位症(AWE)的临床特征，以了解其相关特点。方法：对滨州医学院附属医院在2018年1月至2024年5月期间收治的134例经组织病理证实为剖宫产术后腹壁子宫内膜异位症患者的临床资料进行回顾性分析。根据腹壁子宫内膜异位症病灶的侵袭深度及范围，将其分为皮下脂肪型、鞘膜型和腹膜型三种类型。按照内异症病灶数量分为单发型、多发型。比较腹壁子宫内膜异位症各个分型之间的临床特点及差异。结果：根据术中探查内异症病灶数分型，单发型122例(91%)，多发型12例(9%)。与单发型相比，多发型AWE的手术时间长(P < 0.01)、手术出血量多(P < 0.01)。在手术中探查内异症病灶的深度分型中，发现有19例(14%)属于皮下脂肪型，89例(66%)属于鞘膜型，26例(20%)属于腹膜型。与皮下脂肪型和鞘膜型相比，腹膜型的患者怀孕次数较多(P = 0.035)，手术时间更长(P < 0.01)，并且手术出血量也较大(P < 0.01)，病灶最大径线大(P < 0.01)及CA125水平高(P < 0.01)。结论：3种AWE类型中，鞘膜型发生率最高。腹膜型病灶最大径线大(P < 0.01)及CA125水平高(P < 0.01)。

Abstract: Objective: To investigate the clinical characteristics of abdominal wall endometriosis (AWE) after cesarean section in order to understand its related characteristics. Methods: The clinical data of 134 patients with abdominal wall endometriosis confirmed by histopathology admitted to the Affiliated Hospital of Binzhou Medical University from January 2018 to May 2024 were retrospectively analyzed. According to the invasion depth and scope of abdominal endometriosis, the lesions were classified into subcutaneous lipomatosis, vaginalis, and peritoneum. Based on the number of endometriosis lesions, it can be divided into single types and multiple types. To compare the clinical features and differences among different types of abdominal endometriosis. Results: According to the number of intraoperative investigations, there were 122 cases (91%) of single type and 12 cases (9%) of multiple type. Compared with single-style AWE, multi-style AWE had longer operation time (P < 0.01) and more surgical bleeding (P < 0.01). In the depth classification of intraocular abnormalities, 19 cases (14%) were subcutaneous lipomatosis, 89 cases (66%) were sheath type, and 26 cases (20%) were peritoneal type. Compared with subcutaneous lipidosis and sheath type, peritoneal type patients had more pregnancies (P = 0.035), longer operation time (P < 0.01), and greater surgical bleeding (P < 0.01), larger lesion diameter (P < 0.01) and higher CA125 level (P < 0.01). Conclusion: Among the 3 AWE types, the sheath type has the highest incidence. The maximum diameter of peritoneal lesions was large (P < 0.01), and the level of CA125 was high (P < 0.01).