Ecker Amanda M, Donnellan Nicole M, Shepherd Jonathan P, Lee Ted T M
Department of Obstetrics and Gynecology, Magee-Womens Hospital of UPMC, Pittsburgh, PA.
Am J Obstet Gynecol. 2014 Oct;211(4):363.e1-5. doi: 10.1016/j.ajog.2014.04.011. Epub 2014 Apr 13.
The objective of the study was to review patient characteristics and intraoperative findings for excised cases of abdominal wall endometriosis (AWE).
A 12 year medical record search was performed for cases of excised AWE, and the diagnosis was confirmed on pathological specimen. Descriptive data were collected and analyzed.
Of 65 patients included, the primary clinical presentation was abdominal pain and/or a mass/lump (73.8% and 63.1%, respectively). Most patients had a history of cesarean section (81.5%) but 6 patients (9.2%) had no prior surgery. Time from the initial surgery to presentation ranged from 1 to 32 years (median, 7.0 years), and time from the most recent relevant surgery ranged from 1 to 32 years (median, 4.0 years). Five patients (7.7%) required mesh for fascial closure following the resection of the AWE. We were unable to demonstrate a correlation between the increasing numbers of open abdominal surgeries and the time to presentation or depth of involvement. Age, body mass index, and parity also were not predictive of depth of involvement. There were increased rates of umbilical lesions (75% vs 5.6%, P < .001) in nulliparous compared with multiparous women as well as in women without a history of cesarean section (66.7% vs 1.9%, P < .001).
In women with a mass or pain at a prior incision, the differential diagnosis should include AWE. Although we were unable to demonstrate specific characteristics predictive for AWE, a large portion of our population had a prior cesarean section, suggesting a correlation.
本研究的目的是回顾腹壁子宫内膜异位症（AWE）切除病例的患者特征和术中发现。
对AWE切除病例进行了为期12年的病历检索，并在病理标本上确诊。收集并分析描述性数据。
纳入的65例患者中，主要临床表现为腹痛和/或肿块（分别为73.8%和63.1%）。大多数患者有剖宫产史（81.5%），但6例患者（9.2%）无既往手术史。从初次手术到出现症状的时间为1至32年（中位数为7.0年），从最近一次相关手术到出现症状的时间为1至32年（中位数为4.0年）。5例患者（7.7%）在切除AWE后需要使用补片进行筋膜闭合。我们未能证明开腹手术数量的增加与出现症状的时间或受累深度之间存在相关性。年龄、体重指数和产次也不能预测受累深度。与经产妇相比，未产妇以及无剖宫产史的女性脐部病变发生率更高（分别为75%对5.6%，P <.001；66.7%对1.9%，P <.001）。
对于有既往切口处肿块或疼痛的女性，鉴别诊断应包括AWE。尽管我们未能证明对AWE有预测性的特定特征，但我们的大部分患者有既往剖宫产史，提示存在相关性。
