Diagnosis,Treatment And Prognosis Of Abdominal Wall Endometriosis

Background and ObjectiveAbdominal wall endometriosis(AWE)is a special type of endometriosis between the skin and the parietal peritoneum.Most have a history of previous abdominal surgery,the most common is the history of cesarean operation.Recently,as the cesarean delivery rise,the AWE patients after cesarean operation have an obvious increasing trend.Extension resection of the diseased region is the finest valid therapy method.In case the diseased region is large during the operation and there are many excised tissues resulting in a large epigastric fascia defect,it is often necessary to repair and reinforce with mesh to prevent the occurrence of epigastric incisional hernia.There is still the possibility of recurrence of this disease even after surgical excision of the lesion.There is no consensus at home and abroad on whether the age of onset,incubation period,lesion size,cesarean section number,number of lesions are related to recurrence,and whether combined drug therapy is needed to prevent recurrence after surgery.In addition,the clinical characteristics,diagnostic methods,surgical techniques and therapeutic effects are lack of big data clinical research results.The data of 231 cases of AWE from January 2012 to June 2018 in the firstaffiliated hospital of Zhengzhou for surgical treatment university were retrospectively analyzed and summarized.The contents include clinical characteristics,clinical classification,diagnosis,auxiliary examination,treatment methods and prognostic factors.For the sake of offering certain clinical guidance for efficient diagnosis and therapy of the disease in the future.Materials and Methods1.Clinical data: From January 2012 to June 2018,231 AWE patients were admitted to the first affiliated hospital of zhengzhou university.AWE was separated into subcutaneous fatty type,anterior sheath muscle type and peritoneal type in light of the involvement of the lower boundary of the lesion.If multiple lesions(?2lesions)were detected during the intraoperative exploration,it was classified as the type with the deepest lesion involvement.In term of the diverse therapy measures,they were separated into the matched group(simple surgery)and the observation group(postoperative combined gonadotropin-releasing hormone agonist,or Gn RH-a).The postoperative pathology was endometriosis and the postoperative wound healed well.Postoperative follow-up was conducted until June 2019.2.Statistical methods: Continuous variables using the mean + /-standard deviation,do not accept the normal distribution of continuous variables with rank and inspection,two independent sample continuity correction using chi-square analysis of qualitative data,variety of this quantitative data obey the normal distribution using analysis of variance,multiple pairwise comparisons between the use of LSD-t test,do not obey the normal distribution of the quantitative data adopts diverse Kruskal Wallis test,the qualitative data adopts diverse multiple unordered independent classification data contrast,the association analysis among the two classification changeables employing Pearson chi-square test,All data were analyzed by SPSS 22.0 software,and P < 0.05 was regarded dramatically significant.Results1.Of the 231 AWE patients,229(99.13%,229/231)had a history of cesareansection.The age of morbidity ranged from 22 to 47 years,with an medial age of32.54 ± 4.69 years.The incubation period was 3?156 months,with a median of 24 months.The diameter of the lesion was 1?8cm,with an average diameter of 3.31 ±1.44 cm.2.Of the 231 AWE patients,208(90.04%)presented menstruation-related abdominal wall discomfort,and 183(79.22%)presented abdominal wall palpable nodules.3.Among the three types of lesions,the anterior sheath muscle type was the most common,accounting for 71.6%(164/229).It was characterized by progressively enlarged nodules that could be reached in the abdominal wall,accompanied by pain in the nodules related to menstruation.The subcutaneous fatty type was characterized by a palpable and progressively enlarged tubercle in the abdominal wall.The peritoneal type is characterized by discomfort in the scar of the abdominal wall associated with menstruation.The early nodules are not obvious,and the tender nodules can only be touched when the lesion is large.4.The whole patients conducted superficial color ultrasonography before surgery,with a definite ration of 99.13% and an overall agreement ration of 97.38%with intraoperative probe typing(223/229).Six patients underwent abdominal MRI plain scan,and the diagnosis rate was 100%.5.All the 231 patients underwent surgical treatment,among which 36 cases were repaired with mesh due to the large defect,and the postoperative incision healed well.216 patients with complete case data were followed up,among which 8patients had recurrence,with the recurrence time ranging from 6 months to 2 years after the operation,and the overall recrudesce ration was 3.70%(8/216).There was no statistically significant difference in the recrudesce ration between the Gn RH-a group and the operation group after surgery(4.35% vs.3.53%,P>0.05).There was no statistically significant difference in the mean diameter,number of cesarean sections and number of lesions between the two groups(P>0.05).The mean age and average incubation period of the recurrence group were lower than that of the non-recurrence group,and the difference was statistically significant(P<0.05).Conclusion1.The vast majority of abdominal endometriosis have cesarean section history,often in women of child-bearing age,the length of incubation period varies,with a median of 24 months.2.Different clinical types have different clinical symptoms.Ultrasound examination is helpful for preoperative diagnosis and clinical classification,while MRI examination is helpful for defining the relationship between lesions and surrounding tissues,and is conducive to preoperative evaluation and preparation of special materials.3.Radical surgical excision of the lesion is an effective treatment method.Different lesion sizes have different surgical techniques.4.Postoperative Gn RH-a cannot reduce the recurrence rate,and Early onset age and short incubation period are high risk factors for recurrence.