| Objective To analyze the clinical features,diagnosisand treatment of patients with AWE after cesarean section.Methods A retrospective study of 157 patients collected from International Peace Maternity and Child Health Hospital Affiliated To Shanghai Jiao Tong University School of Medicine from January 2010 to December 2016.These patients had been made a definitediagnosisby pathological examination.The incidence,clinical manifestations,surgery treatment and recurrence was analyzing statistically.Clinical data was analyzing by SPSS 21.0 and P<0.05 considered statistically significant.Results(1)General characteristics: the mean age of the 157 patients with AWE was(32.2 + 3.9)years old.150 cases(95.5%)had a one history of cesarean section 7cases(4.5%)had 2 history of cesarean section.Among them,127 cases were transverse incision,and the other 30 cases was longitudinal incision.147 cases(93.6%)were solitary lesions of the abdominal wall,and multiple abdominal wall lesions were found in 10 cases(6.4%).12 cases(transverse incision in 10 cases,vertical incision in 2 cases)preoperative oral contraceptive treatment for 3-12 months before surgery.4 cases were treated with Gn RH-a for 1-3 months before operation.In 2 cases,because of the difficulty of fascia layer,patch repair was performed.(2)Clinical features: 157 cases of AWE are due to the incision of abdominal wall mass or abdominal wall incision pain for surgery,so 157 cases(100%)had abdominal wall scar pain symptoms,157 cases(100%)of abdominal wall scar can touch mass.The time of transverse incision was significantly shorter than that of longitudinal incision(P=0.008).Theincubation period of multiple abdominal incisions was shorter than that of a single incision(P=0.014).139 cases(88.5%)showed periodic pain related to the menstrual cycle,and in the other 18 cases(11.5%),there was no relationship with the menstrual cycle.(3)Mass location:In the 127 cases of transverse incision,the mass was located in the left side of the incision in 51 cases(38.3%),and the mass was located in the right side of the incision in 59 cases(44.4%),and the mass was located in the middle part of the incision in 23 cases(17.3%).In 30 cases of longitudinal incision,the mass was located in the upper end of the incision in 12 cases(40%),and the mass was located in the lower end of the incision in 14 cases(46.7%),and the mass was located in the middle part of the incision in 4 cases(13.3%).(4)Mass infiltration: in view of the fact that AWE can invade the abdominal wall,we use the upper and lower bound to locate the lesion.The lesions located in the fat layer were 148 cases(88.6%),of which there were simple lesions located in the fat layer in 9 cases(n = 5.4%),and the lower involvement of the anterior rectus sheath and the lesions of the anterior rectus sheath were found in 101 cases(60.4%).The down bound invasive muscle layerwere 28 cases,the lesions of lower invaded peritoneum were 8 cases.The upper bound in the anterior rectus sheathwere 14.Conclusion 1.The typical clinical symptoms of AWE after cesarean section are:cesarean section abdominal incision could touch mass;abdominal incision pain with menstrual cycle;2.AWE is easy occurs at both bound of the incision,so the operation should pay attention to the protection of both bound of the incision to reduce its incidence;3.The time of transverse incision was significantly shorter than that of longitudinal incision.The latency of multiple abdominal incisions was shorter than that of a single incision;4.Most of the AWE lesions are located in the fat layer,so the protection of fat layer can not be ignored;5.To adopt a positive and effective way to reduce the rate of cesarean section,at the same time,to protectabdominal incision protection,it is the key to reduce the incidence rate of AWE. |
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