关键词: 腹壁子宫内膜异位症, 分型, 诊治, 预后, 复发, 恶变

Abstract: Objective  To provide a reference for the clinical characteristics, type, treatment and prognosis of abdominal wall endometriosis (AWE). Methods  This was a retrospective study of 227 AWE patients from January 2015 to December 2021. According to different depth of lesions, the enrolled patients were divided into four types and the clinical characteristics were analyzed. Results  The average age of onset for AWE patients was (35.2±4.6) years, the average number of pregnancies was (1.9±1.2) times, and the average number of deliveries was (1.2±0.5) times. Among them, 225 cases (99.1%) had a previous history of cesarean section, 1 case (0.4%) had only a history of laparoscopic ovarian endometriosis cystectomy, and 1 case (0.4%) was spontaneous AWE. The average latency period of onset was (4.3±3.5) years, and the average duration of the disease was (2.6±2.8) years. The average preoperative CA125 of 129 patients was (37.8±42.7) U/mL, and 42 cases had elevated results (＞35 U/mL). In 16 patients, the incision tension was relatively large after resection of the lesion. Among them, 13 cases underwent artificial mesh placement, and 3 cases underwent autologous tissue repair. All patients underwent postoperative pathological examination, which all indicated AWE, among which 2 cases were malignant. According to the different invasion depths of AWE lesions, they were classified into type I (56 cases, 24.7%), type Ⅱ (91 cases, 40.1%), type Ⅲ (37 cases, 16.3%), and type Ⅳ (43 cases, 18.9%). The comparison results of clinical characteristics in the four types showed that there were statistically significant differences in the number of pregnancies, the number of deliveries, the number of intraoperative lesions, the maximum diameter of the lesion, the mesh implantation rate, and the length of hospital stay (P＜0.05). Excluding the 2 patients with malignant AWE, the average follow-up time after surgery for the 225 AWE patients was (62.2±23.3) months, the symptom relief rate was 99.1% (223/225), the recurrence rate was 7.1% (16/225), and the average recurrence interval was (16.5±9.5) months. There were statistically significant differences in the postoperative recurrence rate and recurrence-free time among the patients of the four types (P＜0.05). In the type Ⅳ group, the recurrence rate was significantly increased, and the recurrence-free time was significantly reduced. Conclusion  AWE can be diagnosed according to the typical clinical manifestations. AWE should be treated immediately once confirmed and taken measures to prevent recurrence. Surgical treatment is the best choice, with high symptom remission rate and low recurrence rate. Malignant transformation of AWE is rare and the prognosis is poor.

Key words: abdominal wall endometriosis, classification, diagnosis and treatment, prognosis, recurrence, malignant transformation