The Clinical Data Analysis Of Abdominal Incisional Endometriosis After Caesarean Section And The Investigation Of Causal Factors

Objective:To retrospectively analyze the clinical data of abdominal incisional endometriosis(AIEM) after caesarean section. To investigate the relation between each causal factor.Methods:Sample collection: 58 patients who had operation in Jingjiang People’s Hospital from 2003.06 to 2013.06 have been selected for this study. They have caesarean section without endometriosis(EMT) outside of pelvis cavity but took a second operation due to abdominal incisional endometriosis(AIEM). Their average age is 32.33±3.85, all in the childbearing age. The 58 patients who took AIEM operations belong to the case group.There are 60 patients who have caesarean history and had operation not due to EMT but due to other Gynecological diseases such as ovarian cyst, fibroid, mature teratoma and hydrosalpinx. The average age is 33.11±3.71, all in the childbearing age. These 60 patients are the control group.By analyzing the patients’ data, summarizing the clinical characteristics and prognosis the retrospective analysis was done. Telephone follow-up were made and the records were analyzed by SPSS19.0 to investigate the factors correlated to AIEM.Result:1. The nursing time and the tide time are both shorter in case group than control group. The longer the nursing time/tide time, the less successful of endometrial implant due to inbody immunity and hormone system.2. In case group the transverse incision rate of caesarean is 86.2%, while in control group the transverse incision rate is 70%. The transverse incision rate of case group is higher than the control group which means the patient took transverse incision may easier get EMT.3. In case group the rate of primary dysmenorrhea is 67.24%, while in control group the rate of primary dysmenorrhea is 31.67%. The rate is much higher in case group then in control group which means the patient who has primary dysmenorrhea may easier get AIEM after caesarean.4. In case group there are 8 patients had uterine cavity operation(13.79%), while in control group there’re only 2(3.33%). There is significant of attack rate between two groups. The patient who had uterine cavity operation after caesarean may easier get AIEM.5. The incubation period correlates with nursing time, tide time and age. And it shows significant difference of AWE attack incubation period between the patients whose menstrual period are 3-7 days or had menarche in age 12-14 and the other patients.6. The AIEM lesion locates mostly on the left and right side of transverse incision, 72.41% where 48% locates on the right side.7. The recurrence rate of patient who had lesion cut range of 0.5-1cm is higher than that of patient who had lesion cut range greater than 1 cm. The recurrence rate of AIEM is higher in patients whose lesion diameter greater than 3 cm.8. The postoperative medication can lower recurrence rate.Conclusion:1. AIEM mostly happens after caesarean. The clinical manifestation is mostly goitre on abdominal wall related to menstruation with recurrent pain. The size changes along menstruation period.2. Ultrasound examination is the first choice to exam AIEM. It can determine the location, size, shape of the lesion and even the infiltrating depth. Serum CA125 doesn’t show obvious increase when exam AIEM, the sensitivity and specificity are both low, not very useful in diagnosis of AIEM. Medical imaging also shows less specificity in diagnosis of AIEM, but it can precisely measure the size and infiltrating depth of lesion and its relation with surrounding structures, which is useful in surgery plan. Since it’s expensive and is normally not used as the first choice for diagnosis.3. Surgical removal of the lesion is the first choice to treat AIEM. The cut range should 1 cm larger than the lesion. Gestrinone, diphereline are given as postoperative medication which can partially decrease the recurrence rate. The recurrence rate of AIEM is higher for those patients whose lesion size greater than 3 cm.4. During the operation process of endometrial debris planting is an important cause of AIEM formation, so we must strictly control the rate of cesarean section, and during the operation according to the flow specification carefully before operation, close the abdominal flushing abdominal wall each layer of tissue, with particular attention to the operation on both sides of the notch is rinsed clean, in order to reduce the occurrence of AIEM.5. The occurrence of AIEM after caesarean is related to nursing time, tide time, with/without primary dysmenorrhea, and with/without uterine cavity operation. Thus it’s useful in reduction of AIEM by prolonging the nursing time, postpone tide time and reducing the uterine cavity operation.6. The incubation period of occurrence of AIEM after caesarean is related to age, menarche age and menstrual period. The incubation period is longer for the patients who is older than 32. The incubation period is longer for the patients who have menarche age between 12-14 years old. The incubation period is shorter for the patients who have 3-7 day period.