| Background and ObjectivesEndometriosis（EMT）is the presence of growing-functioning endometrial tissue（glands and stroma）outside the body of the uterus.Its incidence rate is high and rising year by year,seriously affecting women’s physical and mental health.Laparoscopic diagnosis,surgery and drug therapy are the "gold standard" treatment for endometriosis,but surgical treatment is the main treatment.The choice of surgical method and surgical scope are the hot spots of clinical research in the treatment of endometriosis.Abdominal wall endometriosis（AWE）is a special type of endometriosis in which endometrial tissue（glands and stroma）appears at an incision in the abdominal wall.With the increase of delivery volume and cesarean section rate,the incidence of endometriosis in perineum and abdominal wall is gradually increasing,and the endometriosis related to pregnancy and delivery is gradually increasing,which needs to cause clinical attention.This study aims to explore and analyze the characteristics and development trend of surgical treatment of endodynia in Qi Lu Hospital of Shang Dong University from 2007 to 2017 by summarizing and analyzing the composition of surgical methods,classification composition and special site endodynia.At the same time,the data range of the cases of abdominal wall and perineal disorders outside the pelvic cavity was expanded to December 31,2020 for analysis and follow-up,to explore the clinical characteristics,treatment methods and risk factors for recurrence of abdominal wall and perineal disorders,in order to provide reference for the diagnosis,treatment and prevention of abdominal wall and perineal disorders.Information and MethodsReview of Qi Lu Hospital of Shang Dong University from January 1,2007 to 2017 on December 31,all cases of endometriosis operation,a total of 3007 cases collected hospitalization number,age,hospitalization time,discharge time,the main diagnosis,hospitalization and discharge diagnosis and operation time,surgical procedure and postoperative pathological details,classified according to the operation method,type,vintage,compare different operation mode and type of operation in different disease,were analyzed in different disease surgery way form characteristics,trends and parting forming characteristics.The age and pathological results of patients were classified and compared to analyze the clinical characteristics of age-related endometriosis.For expanding the scope of the clinical data and review of the abdominal wall and perineal endometriosis cases from January 1,2007 to December 31,2020,the review of cases of a total of 359 cases,collecting demographic characteristics,signs and symptoms,medical history,surgical methods and types,pathological results clinical data,laboratory examination and imaging examination,and different disease within the abdominal wall and perineal follow-up,understand in the abdominal wall and perineal disease relapse,analysis of risk factors of recurrence.Statistical methods using SPSS 24.0 software for data collection and analysis,the mean+/-standard deviation describes obey normal distribution count data,using independent sample t-test and single factor analysis of variance（ANOVA）to compare differences between groups,using the median and quartiles describe the non-normal distribution count data,the Mann-Whitney U or Kruskal Wallis H test to compare differences between groups;Frequency and composition ratio were used to describe the distribution of measurement data,and chi-square test was used to compare the differences between groups.All tests in this paper were two-sided tests,and P<0.05 was considered statistically significant.The results of the study1.From 2007 to 2017,a total of 3007 cases of endometriosis were confirmed by surgery,with ovarian type accounting for 85.99%and scar type accounting for 8.71%.Among 3007 cases,2398 cases（79.75%）underwent laparoscopic surgery.The proportion of laparoscopic surgery increased to 86.25%from 2012 to 2017,significantly higher than 61.99%from 2007 to 2011（P<0.001）.The proportion of laparoscopic surgery in patients with conservative endodynia increased to 87.29%from 2012 to 2017,significantly higher than 64.09%from 2007 to 2011（P<0.001）.Laparoscopic surgery was significantly higher than open surgery（79.75%vs 10.81%）.2.A total of 322 patients with abdominal endometriosis were collected.The onset time of subcutaneous endometriosis was significantly earlier than sheath endometriosis（P=0.020）,but the incubation period showed no significant difference（P=0.320）.The abdominal wall masses of subcutaneous type were significantly smaller than those of sheath type（P<0.001）.CA125 was detected in 159 patients with intra-abdominal abnormalities,and there was a statistically significant difference between 68 cases of subcutaneous CA125 and 91 cases of sheath CA125（P=0.002）.3.163 cases of abdominal endometriosis were followed up,of which 16 cases（9.82%）had recurrence.The patients were divided into the non-recurrence group（n=147）and the recurrence group（n=16）,and there were no statistically significant differences in age,onset time,incision type,mean intraoperative diameter of lesions,classification,postoperative drug therapy,breast-feeding status,and postoperative pregnancy status.Whether relapse as dependent variable,age,time,type of incision,average diameter of lesions,parting,whether to accept medication after operation,whether breast-feeding and whether postoperative pregnancy again as independent variables,using multiple factors of input binary logistic regression analysis,the results showed that after cesarean section surgery again the pregnancy childbirth affect the independent risk factors of recurrence（P=0.046）.4.Thirty-seven cases of perineal endometriosis,31 cases of lateral incision delivery（83.78%）and 6 cases of perineal laceration（16.22%）were collected.18.92%（7/37）of the patients had recurrence after surgical treatment,and all of them were lateral incision delivery patients.A total of 23 patients were followed up,of which 2（8.70%）had postoperative recurrence,all of which were lateral incision delivery patients.The research conclusion1.Intrapelvic heterotopia is mainly ovarian type,and intraabdominal heterotopia is the most common.Laparoscopic conservative surgery with fertility preservation is the main surgical method for intrapelvic heterotopia.2.The diagnosis and classification of ectopia in the abdominal wall can be determined according to ultrasound and blood flow signal.CA125 is meaningless to the diagnosis of ectopia in the abdominal wall.Subcutaneous type has early onset and small abdominal wall mass.Lactation had no effect on the disease.Postoperative drug therapy had no effect on recurrence.Abdominal wall abnormalities after cesarean delivery again easily cause abdominal wall abnormalities recurrence.3.Lateral incision delivery is a risk factor for the occurrence and recurrence of endometriosis in perineum. |
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