目的:根据腹壁子宫内膜异位症(AWE)的组织浸润程度,并比较不同类型AWE的临床特点差异。
方法:在本研究中,我们回顾性分析2008年1月至2018年12月在北京协和医院行腹壁子宫内膜异位症病灶切除术的367例患者的临床资料,并根据病灶浸润程度的不同将患者分为3种类型.I型指定侵入皮肤和皮下组织;II型,筋膜和腹直肌;和III型,腹膜。我们进行了分类,比较,并分析了一般情况,临床表现,辅助考试,手术条件,术后情况,以及患者的复发状况。
结果:在367名患者中,Ⅰ型患者占13.62%,Ⅱ型患者占56.68%,和III型为29.7%。关于群体比较,我们观察到,随着质量的位置加深,并发盆腔子宫内膜异位症的发生率增加(P=0.007),复发性AWE增加(P=0.02),质量的大小增加(P<0.001),多发性病变的发生率升高(P<0.001),网孔植入率增加(P<0.001),术后住院时间延长(P<0.001),术后发热例数增加(P=0.006),引流放置的风险增加(P<0.001)。5年累积复发率为3.3%,不同类型AWE的复发率差异无统计学意义。
结论:III型AWE具有更严重的临床表现,较大的病变大小,更长的手术时间,术中手术难度较大,网状物植入的必要性更高,术后恢复过程更长。完全切除AWE病变是主要的治疗方法,长期复发率相对较低。
To classify abdominal wall endometriosis (AWE) according to the invasive levels of tissue mass, and to compare the differences in clinical characteristics between different types of AWE.
In this study, we retrospectively analyzed the clinical data of 367 patients who had undergone resection of abdominal-wall endometriotic lesions at the Peking Union Medical College Hospital from January 2008 to December 2018, and we divided the patients into three types according to their deepest level of lesion invasion. Type I designated invasion of skin and subcutaneous tissue; type II, of fascia and rectus abdominis; and type III, of peritoneum. We classified, compared, and analyzed the general conditions, clinical manifestations, auxiliary examinations, surgical conditions, postoperative conditions, and recurrence status of patients.
Of the 367 patients, type I patients accounted for 13.62%, type II patients for 56.68%, and type III for 29.7%. With respect to group comparisons, we observed that as the location of the mass deepened, the rate of concurrent pelvic endometriosis increased (P = 0.007), recurrent AWE was augmented (P = 0.02), the size of the mass increased (P < 0.001), the rate of multiple lesions became elevated (P < 0.001), the rate of mesh implantation increased (P < 0.001), the length of postoperative hospital stay (P < 0.001) was lengthened, the number of postoperative fever cases (P = 0.006) increased, and the risk of drainage placement (P < 0.001) was enhanced. The 5-year cumulative recurrence rate was 3.3%, and there was no significant difference in the recurrence rate among various types of AWE.
Type III AWE carries more severe clinical manifestations, larger lesion size, longer operative time, greater intraoperative surgical difficulty, higher necessity of mesh implantation, and longer postoperative recovery process. Complete resection of AWE lesion is the main therapeutically approach and shows relatively low long-term recurrency rate.