Koger K E, Shatney C H, Hodge K, McClenathan J H
Department of General Surgery, Stanford University School of Medicine, California.
Surg Gynecol Obstet. 1993 Sep;177(3):243-6.
Relatively few instances of surgical scar endometrioma have been reported. Herein we review 24 patients treated for this condition at the institutions at which we work between 1972 and 1992. The age of the patients ranged from 17 to 47 years, with an average age of 31.7 years. Surgical scar endometriomas occurred after operations including cesarean section (19 patients), appendectomy (two patients), episiotomy (two patients) and hysterectomy (one patient). The interval between prior surgical treatment and the onset of symptoms ranged from one to 20 years, with an average of 4.8 years. All patients were treated by wide excision. Seventeen of 24 patients were available for follow-up evaluation. The interval between excision and follow-up evaluation ranged from 1.2 to 14.0 years, with an average of 6.4 years. None of the patients had recurrence of surgical scar endometrioma. Patients with the classic presentation of a painful surgical scar mass that increases in size or tenderness during menstruation need no further evaluation of the lesion before excision. Ultrasonographic examination and fine needle aspiration biopsy should be used preoperatively in women who have a constantly painful or asymptomatic mass in a surgical scar. Because medical management yields poor results, wide excision of surgical scar endometriomas is the treatment of choice.
外科手术瘢痕子宫内膜异位症的报道相对较少。在此，我们回顾了1972年至1992年间在我们工作的机构接受该疾病治疗的24例患者。患者年龄在17岁至47岁之间，平均年龄为31.7岁。手术瘢痕子宫内膜异位症发生于包括剖宫产（19例）、阑尾切除术（2例）、会阴切开术（2例）和子宫切除术（1例）等手术后。上次手术治疗与症状出现之间的间隔时间为1年至20年，平均为4.8年。所有患者均接受了广泛切除治疗。24例患者中有17例可进行随访评估。切除与随访评估之间的间隔时间为1.2年至14.0年，平均为6.4年。所有患者均未出现手术瘢痕子宫内膜异位症复发。对于具有典型表现，即月经期间手术瘢痕处疼痛性肿块大小或压痛增加的患者，在切除前无需对病变进行进一步评估。对于手术瘢痕处有持续疼痛或无症状肿块的女性，术前应进行超声检查和细针穿刺活检。由于药物治疗效果不佳，广泛切除手术瘢痕子宫内膜异位症是首选治疗方法。
