發(fā)布時間：2018-03-29 09:55

  本文選題：剖宮產術　切入點：腹壁子宮內膜異位癥　出處：《吉林大學》2014年碩士論文

【摘要】：背景和目的：子宮內膜異位癥(endometriosis, EMT)，簡稱“內異癥”，是指具有生長功能的子宮內膜組織(腺體和間質)出現(xiàn)在子宮腔被覆內膜及宮體肌層以外的其他部位。該病屬于良性疾病，但因其表現(xiàn)有增生、浸潤、轉移等的惡性生物學行為，故有“良性癌”之稱。該病好發(fā)于盆腔內，以卵巢最為常見，盆腔外比較少見。腹壁子宮內膜異位癥(abdominal wall endometriosis,AWE)是最常見的盆腔外子宮內膜異位癥,最多見于剖宮產術后切口瘢痕處，，國內研究表明,剖宮產術后AWE發(fā)生率0.03%~0.47%。近年來，我國剖宮產手術率一直居高不下,腹壁子宮內膜異位癥的發(fā)病率也開始逐年增高，給患者的身心帶來痛苦，同時也增加了經濟負擔。本研究回顧性分析2009年2月至2013年7月在吉林大學白求恩第一醫(yī)院收治的79例腹壁子宮內膜異位癥患者的臨床資料，探討影響腹壁子宮內膜異位癥的發(fā)生、臨床特點以及預后的相關因素，希望為今后減少腹壁子宮內膜異位癥的發(fā)病率及術后復發(fā)率提供參考。 方法：對已行手術切除病灶并有術后病理明確診斷的79例剖宮產術后AWE患者的臨床資料進行回顧性分析并電話隨訪，收錄結果經SPSS17.0軟件進行統(tǒng)計學分析。 結果： 1.線性回歸分析提示該病潛伏期與發(fā)病年齡呈正相關(r=0.326，P=0.003)，其差異有統(tǒng)計學意義；潛伏期與剖宮產年齡、月經周期呈負相關，但其差異均無統(tǒng)計學意義。 2.發(fā)病年齡30歲(39例)的研究對象其發(fā)病潛伏期與年齡≤30歲者(40例)相比，時間明顯延長，差異具有統(tǒng)計學意義(t=-2.217,P=0.03)；月經周期≥28天的研究對象（62例）其發(fā)病潛伏期較周期＜28天者（17例）時間長，影響差異具有統(tǒng)計學意義（t=-2.639，P=0.01）；而剖宮產年齡＞30歲（9例）的患者與年齡≤30歲（70例）的患者對發(fā)病潛伏期影響無顯著性差異（t=1.206，P=0.208）。 3.79例患者均于術前診斷為腹壁子宮內膜異位癥，治療方法為行手術切除病灶，術中切緣距病灶邊緣0.5-1.0cm，術后追加藥物輔助治療的患者19例。 4.79例研究對象中僅有63例成功隨訪，其中20.6%（13/63）再次出現(xiàn)瘢痕處疼痛，有2例研究對象切口周圍可觸及明顯包塊，與月經周期有關，臨床診斷為AWE復發(fā)。13例復發(fā)患者中：有3例患者術中病灶＞3cm；有9例為橫行剖宮產切口；有9例術后未追加藥物輔助治療。 結論： 1.嚴格控制剖宮產指征，降低剖宮產率是降低AWE發(fā)病率的關鍵。 2.腹壁子宮內膜異位癥患者的發(fā)病年齡及月經周期是該病潛伏期的影響因素，而患者的剖宮產年齡與該病無明顯相關性。 3.腹壁橫切口的AWE患者其發(fā)病率及復發(fā)率均高于縱切口，支持異位內膜種植學說，故剖宮產切口的選擇及其術中切口的保護成為降低AWE發(fā)病率和復發(fā)率的另一重要因素。
[Abstract]:Background & AIM: endometriosis endometriosis (EMTA) refers to the presence of endometrial tissues (glands and stroma) with growth function in other parts of the uterine cavity other than the endometrium and the myometrium of the uterine body. The disease is a benign disease. However, it is known as "benign cancer" because of its malignant biological behavior such as hyperplasia, infiltration, metastasis, etc. The disease is common in the pelvic cavity, especially in the ovary. Endometriosis of abdominal wall wall endometriosis is the most common pelvic endometriosis, most commonly seen in scar of incision after cesarean section. Domestic studies show that the incidence of AWE after cesarean section is 0.03 and 0.47. In recent years, The rate of cesarean section is always high in our country, and the incidence of endometriosis in the abdominal wall is increasing year by year, which brings pain to the patients' body and mind. From February 2009 to July 2013, we retrospectively analyzed the clinical data of 79 patients with abdominal endometriosis treated in the first Hospital of Bai Qiuen, Jilin University. To explore the related factors affecting the occurrence, clinical characteristics and prognosis of abdominal endometriosis, and to provide a reference for reducing the incidence and recurrence rate of abdominal wall endometriosis in the future. Methods: the clinical data of 79 patients with AWE after cesarean section were retrospectively analyzed and followed up by telephone. The results were analyzed by SPSS17.0 software. Results:. 1. Linear regression analysis showed that there was a positive correlation between the latent period and the onset age, the difference was statistically significant, and the latency was negatively correlated with the age of cesarean section and menstrual cycle, but the difference was not statistically significant. 2. The onset latency of 39 patients with onset age of 30 years old was significantly longer than that of 40 patients with age 鈮

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