A Retrospective Study On Clinical Data Of101Cases With Abdominal Incisional Endometriosis

Objective:The aim is to analysis the clinical features, diagnosis, treatment and recurrence of the abdominal wall endometriosis and further discuss the ideal treatment and effective prevention.Methods:A retrospective study of101patients collected from QiLu hospital of Shandong University from January2006to November2013. These patients had been made a definite diagnosis by pathological examination. The incidence, clinical manifestations, surgery, drug treatment and recurrence was analyzing statistically. Clinical data was analyzing by SPSS18.0and P<0.05considered statistically significant.Results:(1) The incidence of abdominal incisional endometriosis was2.76%(101/3654). Except one case had a history of hysterotomy for terminating pregnancy, the other cases had a history of cesarean section. The mean age was32.3±4.4years(range23～45years).(2) The average time between the onset of symptoms and previous surgery was34.8±24.9months (range1～120months). The duration of disease, defined to be the time interval between the onset of symptoms and surgery, median was18months (range1-126months).70.3%of patients had classical symptoms, that was a painful subcutaneous mass together with a cyclic pain associated with menses.(3) The preoperative diagnosis was correct in95%(96/101). In the42abdominal incisional endometriosis cases, which detected the preoperative serum CA125, only12 (28.6%) cases had elevated serum CA125. The range of CA125was5.74～187U/ml and the median was24.21U/ml.84cases had a pre-operational ultrasonography and the rate of correctly diagnosis was79.8%(67/84). Only76.2%(64/84) of patients with abdominal incisional endometriosis were found to have infiltrating depth by pre-operative ultrasonography.9patients had MRI examination before surgery, the correctly diagnosis was100%and MRI all could assess the infiltrating depth.(4) All patients underwent a surgery to completely excise lesions on the abdominal wall, and only2patients required patch grafting because of large abdominal wall defects after tumor resection.12.9%(13/101) of patients had preoperative drug therapy and24.8%(25/101) had drug treatment after operation.(5)10.5%(9/86) of cases followed up had cyclical abdominal pain or abdominal mass again, the median time of relapse was6months (range3～48months).Conclusions:(1) Preoperative ultrasonography is available for the diagnosis of the abdominal insional endometriosis. MRI examination was useful to determine the location and depth of infiltration in surrounding tissues, and for preoperative evaluation further.(2) Serum CA125is not useful for the diagnosis of AIEM.(3) Surgical excision is the primary treatment for AIEM. But for the large defect of abdominal wall, a mesh is needed to repair the abdominal wall.(4) Abdominal incisional endometriosis is commonly considered to be caused by the iatrogenic implantation of endometrium into the surgical wound during cesarean section. So the effective prevention is a tight control of indications for cesarean section and reducing the rate of cesarean section.