Minaglia Steven, Mishell Daniel R, Ballard Charles A
From the Division of Female Pelvic Medicine and Reconstructive Surgery, Department of Obstetrics and Gynecology, Keck School of Medicine, University of Southern California, Los Angeles, USA.
J Reprod Med. 2007 Jul;52(7):630-4.
To review a series of women with endometriomas developing in the scar of the skin incision performed for cesarean section.
A total of 37 patients diagnosed with incisional endometrioma at the time of surgical excision from 1975 to 2005 were identified from the comprehensive surgical database, which includes all operative procedures performed at this institution. The medical records of 33 of the 37 patients were available for review.
The endometriomas ranged in size from a diameter of 1-12 cm and were initially observed to be present 6 months to 9 years (mean, 3.2) after the surgical procedure. Diagnosis was best made by needle aspiration of chocolate colored fluid from the mass. Medical therapy with a gonadotropin releasing hormone agonist, medroxyprogesterone acetate or combination oral contraceptives had been attempted in 14 patients without a change in lesion size. All patients were cured by surgical excision of the endometrioma.
The overall incidence of incisional endometriomas following cesarean section during the 30-year period was 0.08%. Optimal treatment is by surgical excision. It is hypothesized that failure to close the parietal and visceral peritoneum with sutures at the time of cesarean section may markedly increase the postoperative occurrence of an endometrioma in the skin incision scar.
回顾一系列在剖宫产皮肤切口瘢痕处发生的卵巢巧克力囊肿病例。
从综合外科数据库中识别出1975年至2005年间手术切除时被诊断为切口子宫内膜异位症的37例患者，该数据库包含了本机构进行的所有手术操作。37例患者中有33例的病历可供查阅。
卵巢巧克力囊肿直径为1 - 12厘米，最初在手术后6个月至9年（平均3.2年）被发现。通过从肿块中抽出巧克力色液体进行针吸检查可做出最佳诊断。14例患者尝试使用促性腺激素释放激素激动剂、醋酸甲羟孕酮或复方口服避孕药进行药物治疗，但病变大小无变化。所有患者通过手术切除卵巢巧克力囊肿得以治愈。
在这30年期间，剖宫产术后切口子宫内膜异位症的总体发病率为0.08%。最佳治疗方法是手术切除。据推测，剖宫产时未用缝线缝合壁层和脏层腹膜可能会显著增加皮肤切口瘢痕处术后子宫内膜异位症的发生率。
