Liang C C, Liou B, Tsai C C, Chen T C, Soong Y K
Department of Obstetrics and Gynacology, Chang Gung Memorial Hospital, Taipei, Taiwan, Republic of China.
Int Surg. 1998 Jan-Mar;83(1):69-71.
Scar endometriosis may develop after pelvic operations, such as cesarean section, tubal ligation, hysterotomy and hysterectomy. This prompted us to demonstrate the proper diagnosis; management and prophylactic procedure of scar endometriosis.
Twelve patients with scar endometriosis were diagnosed by clinical symptoms and signs, including a painful scar mass related to the menstrual cycle and cyclic bleeding from scars. Preoperative ultrasound needle aspiration cytology was arranged in three patients without painful mass. The management comprised complete surgical excision and selective medical treatment. Postoperative follow-up was scheduled at six-month intervals.
Except for two patients who complained of scar pain but no palpable mass during menstruation, there was no evidence of recurrence in the other 10 patients.
Diagnosis of scar endometriosis should involve detailed history taking and pelvic examination. Concerning the role of needle aspiration cytology, it still remains controversial. Several prophylactic procedures have been presented to prevent decidual contamination of the wound. Complete surgical excision including the adjacent fascia or skin is the proper treatment of scar endometriosis.
瘢痕子宫内膜异位症可能在剖宫产、输卵管结扎、子宫切开术和子宫切除术等盆腔手术后发生。这促使我们阐述瘢痕子宫内膜异位症的正确诊断、管理及预防措施。
12例瘢痕子宫内膜异位症患者通过临床症状和体征确诊，包括与月经周期相关的疼痛性瘢痕肿块及瘢痕处周期性出血。3例无疼痛性肿块的患者术前安排了超声引导下针吸细胞学检查。治疗包括完整手术切除及选择性药物治疗。术后随访安排为每6个月一次。
除2例患者在月经期间主诉瘢痕疼痛但未触及肿块外，其他10例患者均无复发迹象。
瘢痕子宫内膜异位症的诊断应包括详细的病史采集和盆腔检查。关于针吸细胞学检查的作用，仍存在争议。已提出多种预防措施以防止伤口蜕膜污染。包括相邻筋膜或皮肤的完整手术切除是瘢痕子宫内膜异位症的恰当治疗方法。
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