Department of Digestive and Colorectal Surgery, Centre of Minimal Invasive Surgery, Molinette Hospital, University of Turin, Cso A.M. Dogliotti 14, 10126, Turin, Italy,
Surg Today. 2014 Apr;44(4):767-72. doi: 10.1007/s00595-012-0459-3. Epub 2013 Jan 12.
Endometriosis is a common disorder in females of reproductive age. Surgical scar endometrioma after cesarean section develops in 1-2% of patients, and usually presents as a tender and painful abdominal wall mass. The diagnosis is suggested by pre or perimenstrual pelvic pain and is often established only by histology. In this retrospective observational cohort study, we reviewed the medical records of five patients with a histopathological diagnosis of scar endometriosis. A scar mass was found on a previous Pfannenstiel incision in four patients and in a median cesarean section in one patient. The mean age at diagnosis (38.6 years, median 38) was older than reported elsewhere. A histological examination of the surgical specimen confirmed the diagnosis of endometriosis in all cases. During the follow-up period (mean 34.6 months), local recurrence (n = 1) and pelvic recurrence (n = 1) were treated surgically. Surgery is the treatment of choice for surgical scar endometriosis. Excision with histologically proven free surgical margins of 1 cm is mandatory to prevent recurrence. As scar endometriosis may be associated with pelvic localization, explorative abdominal laparoscopy may be indicated to exclude the intraperitoneal spread of the disease in symptomatic patients.
子宫内膜异位症是生育年龄女性的一种常见疾病。剖宫产术后手术瘢痕内子宫内膜异位症在 1-2%的患者中发展，通常表现为腹部壁痛性肿块。诊断依据为经前或经期盆腔痛，且通常仅通过组织学确定。在这项回顾性观察队列研究中，我们复习了五例经组织病理学诊断为瘢痕内异症患者的病历。四名患者的 Pfannenstiel 切口和一名患者的中位剖宫产切口处发现了瘢痕肿块。诊断时的平均年龄（38.6 岁，中位数 38）大于其他地方报道的年龄。所有病例的手术标本组织学检查均证实为内异症。在随访期间（平均 34.6 个月），1 例局部复发（n=1）和 1 例盆腔复发（n=1）均行手术治疗。手术是治疗手术瘢痕内异症的首选方法。必须进行组织学证实的 1 厘米游离手术切缘的切除，以防止复发。由于瘢痕内异症可能与盆腔定位有关，对于有症状的患者，可能需要进行剖腹腹腔镜探查以排除疾病的腹腔内播散。
