CAJ | 학술논문

目的：探讨剖宫产术后腹壁子宫内膜异位症（ abdominal wall endometriosis ， AWE）的病灶特点，探讨相应的防范措施。方法2002年2月～2011年8月对86例剖宫产术后AWE，在腰硬联合麻醉或全身麻醉下在病灶外0．5～1 cm逐层切开病灶周围组织，至病灶及其周边组织完全切除，探查无其他病灶存留，生理盐水冲洗手术创面，可吸收线间断缝合，关闭筋膜、皮下脂肪层，皮内缝合皮肤。结果病灶直径0．8～7．0 cm，平均3．2 cm。单个病灶78例，≥2个病灶13例，共切除94个病灶；86个病灶（91．5％，86/94）位于切口两侧，8个病灶（8．5％，8/94）位于切口中间。病灶累及腹壁组织：脂肪＋筋膜占51．2％（44/86），筋膜＋肌层占16．3％（14/86）。病灶大小直径平均3．2 cm （0．8～7．0 cm）。术后病理结果均为腹壁子宫内膜异位症。61例随访2～118个月，复发率11．5％（7/61），无恶变。结论剖宫产术后AWE病灶多位于切口两侧，并累及脂肪、筋膜及肌层。在剖宫产术中需要保护切口，彻底冲洗腹壁切口。
목적：탐토부궁산술후복벽자궁내막이위증（ abdominal wall endometriosis ， AWE）적병조특점，탐토상응적방범조시。방법2002년2월～2011년8월대86례부궁산술후AWE，재요경연합마취혹전신마취하재병조외0．5～1 cm축층절개병조주위조직，지병조급기주변조직완전절제，탐사무기타병조존류，생리염수충세수술창면，가흡수선간단봉합，관폐근막、피하지방층，피내봉합피부。결과병조직경0．8～7．0 cm，평균3．2 cm。단개병조78례，≥2개병조13례，공절제94개병조；86개병조（91．5％，86/94）위우절구량측，8개병조（8．5％，8/94）위우절구중간。병조루급복벽조직：지방＋근막점51．2％（44/86），근막＋기층점16．3％（14/86）。병조대소직경평균3．2 cm （0．8～7．0 cm）。술후병리결과균위복벽자궁내막이위증。61례수방2～118개월，복발솔11．5％（7/61），무악변。결론부궁산술후AWE병조다위우절구량측，병루급지방、근막급기층。재부궁산술중수요보호절구，철저충세복벽절구。
Objective To analyze the distribution characteristic of abdominal wall endometriosis after cesarean section , and discuss the precautionary measure . Methods The clinical data of 86 cases admitted to our hospital for surgery due to abdominal wall endometriosis after cesarean section between February 2002 and August 2011 were collected and analyzed .The patients received combined spinal-epidural anesthesia or general anesthesia .The surrounding tissue away from the lesion by 0.5 to 1 cm was incised layer by layer, until the lesion was removed completely .The wounds were douched with normal saline when no lesions remained .The fascia and subcutaneous adipose layer were closed by interrupted sutures with absorbable thread , and the skin by intradermal sutures . Results All cases with 94 lesions(13 cases had more than one lesion ) underwent local lesion resection; 91.5% (86/94) of the lesions were located on both sides of the incisions and 8.5%(8/94) in the middle.In 44 cases (51.2%, 44/86), the fat and fascia of abdominal wall were mainly involved; in 14 cases (16.3%, 14/86), fascia and muscular were involved.All lesions were pathologically confirmed.A total of 61 patients were followed up for 2 to 118 months, and the recurrence rate was 11.45% (7/61), without malignant transformation in all cases . Conclusions Most of the abdominal wall endometriosis lesions after cesarean section are located on both sides of the incisions ,with fat, fascia and muscular being involved .It is recommended to protect the incision intraoperatively and thoroughly wash the incision .