袁迎九　后建丽　丁文清

[摘要] 目的 探讨剖宫产术后腹壁切口子宫内膜异位症的临床诊断及治疗情况。 方法 选取2005年10月～2012年8月经手术治疗腹部切口子宫内膜异位的患者30例，对30例患者的临床资料进行回顾性分析。 结果 30例腹部切口子宫内膜异位症患者4例病灶累及腹膜，5例累及肌层，14例累及腹肌前鞘。行异位病灶切除手术，手术效果良好，无复发。手术患者病灶均为一次手术切除，30例手术的患者完全治愈，治愈率100%。病理检查增生的结缔组织中可以见到子宫内膜腺体结构及间质细胞。符合子宫内膜异位症的诊断。术后23例患者随访1～3年，无复发病例。 结论 剖宫产手术是腹壁切口子宫内膜异位症最重要的医源性因素，应严格依照剖宫产手术适应证可降低剖宫产率，手术是唯一有效的治疗方法；规范手术操作是预防本病发生的关键。

[关键词] 剖宫产后；腹壁切口；子宫内膜异位症；临床治疗；手术切口

[中图分类号] R711.71 [文献标识码] B [文章编号] 2095-0616（2014）17-142-03

[Abstract] Objective To explore the clinical diagnosis and treatment of abdominal incisional endometriosis after cesarean section. Methods 30 patients who received surgery of abdominal incisional endometriosis from October 2005 to August 2012 were selected.Clinical data of the 30 patients were retrospectively analyzed. Results 4 of 30 patients with abdominal incisional endometriosis had foci involving peritoneum，5 involving muscular layer，and 14 involving protheca of abdominal muscle.Incision of ectopic foci was carried out and the surgical effect was good without any relapse.All patients received the incision of foci only once.All the 30 patients completely recovered with the recovery rate of 100%.Hyperplastic connective tissues via pathological examination showed endometrial glandular structure and interstitial cells.The results accorded with the diagnosis of endometriosis.23 patients received follow-ups after the surgery for 1-3 years，and no relapses were detected. Conclusion Cesarean section is the main iatrogenic factor causing abdominal incisional endometriosis.Treatment strictly following surgical indications of Cesarean section helps reduce the rate of Cesarean section， and surgery is the only effective treatment for endometriosis；standardized surgical procedures are the key to prevent the disease.

[Key words] After cesarean section；Abdominal incision；Endometriosis；Clinical treatment；Surgical incision

子宫内膜异位症是育龄妇女的常见疾病，易发生在盆腔，腹膜和卵巢以及子宫肌壁，但切口腹壁子宫内膜异位症在临床上较少见[1-2]。随着人们的生活水平提高，人们越来越安逸，年轻夫妻害怕疼痛，不管需不需要的，都要求医生剖宫产，而且还越来越受欢迎。其实剖宫产，对妻子的身体有一定的影响，而且还有一些并发症，剖宫产的手术难免有一些处理的不好的，可能有少许的子宫内膜组织流入伤口，形成子宫内膜异位症。……