Zhang Ping, Sun Yabing, Zhang Chen, Yang Yeping, Zhang Linna, Wang Ningling, Xu Hong
The International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, 200030, China.
Department of Assisted Reproduction, Shanghai Ninth People's Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, 200011, China.
BMC Womens Health. 2019 Jan 18;19(1):14. doi: 10.1186/s12905-019-0711-8.
Cesarean scar endometriosis (CSE) is the most common type of abdominal wall endometriosis (AWE). The aim of this study was to systematically identify the clinical features of CSE and recommend precautionary measures.
A large, retrospective study was undertaken with CSE patients treated surgically at our hospital between January 2005 and December 2017.
A total of 198 CSE patients were enrolled, with a mean age of 32.0 ± 4.0 years. The main complaint of the patients was abdominal mass (98.5%), followed by cyclic pain (86.9%). The latency period of CSE was 31.6 ± 23.9 months, and the duration between the onset of symptoms and this surgery was 28.3 ± 25.0 months. A majority (80.8%, n = 160) of the patients had undergone a Pfannenstiel incision, and a minority (19.2%, n = 38) a vertical midline incision. The latency period of CSE in the case of a Pfannenstiel incision was significantly shorter than that in the case of a vertical midline incision (24.0 vs 33.0 months, P = 0.006). A total of 187 (94.4%) patients had a single endometrioma, 11 (5.6%) patients had multiple endometriomas, and the 11 multiple-endometrioma patients had all undergone a Pfannenstiel incision. Lesions of endometrioma were common in corner sites, after either incision: 142/171 (83.0%) in Pfannenstiel incision scars and 32/38 (84.2%) in vertical incision scars.
The findings of this study indicate that the Pfannenstiel incision carries a higher risk of CSE than the vertical midline incision. Thorough cleaning at the conclusion of CS, particularly of both corner sites of the adipose layer and the fascia layer, is strongly recommended for CSE prevention. Further studies might provide additional recommendations.
剖宫产瘢痕子宫内膜异位症（CSE）是腹壁子宫内膜异位症（AWE）最常见的类型。本研究的目的是系统地确定CSE的临床特征并推荐预防措施。
对2005年1月至2017年12月期间在我院接受手术治疗的CSE患者进行了一项大型回顾性研究。
共纳入198例CSE患者，平均年龄32.0±4.0岁。患者的主要主诉是腹部肿块（98.5%），其次是周期性疼痛（86.9%）。CSE的潜伏期为31.6±23.9个月，症状出现至手术的时间为28.3±25.0个月。大多数（80.8%，n = 160）患者采用耻骨联合上横切口，少数（19.2%，n = 38）采用腹部正中纵切口。耻骨联合上横切口患者CSE的潜伏期明显短于腹部正中纵切口患者（24.0个月对33.0个月，P = 0.006）。共有187例（94.4%）患者有单个子宫内膜瘤，11例（5.6%）患者有多个子宫内膜瘤，11例有多个子宫内膜瘤的患者均采用耻骨联合上横切口。无论采用哪种切口，子宫内膜瘤病变在切口角部常见：耻骨联合上横切口瘢痕中142/171（83.0%），腹部正中纵切口瘢痕中32/38（84.2%）。
本研究结果表明，耻骨联合上横切口发生CSE的风险高于腹部正中纵切口。强烈建议剖宫产结束时彻底清理，尤其是脂肪层和筋膜层的两个角部，以预防CSE。进一步的研究可能会提供更多建议。
