腹壁子宫内膜异位症疾病特征Meta分析

doi:10.7504/fk2014090119

摘要/Abstract

摘要：

目的探讨腹壁子宫内膜异位症（abdominal wall endometriosis，AWE）患者的疾病特征。方法通过PubMed检索，检索词为：abdominal wall endometriosis, extrapelvic endometriosis, scar endometriosis, incisional endometriosis, inguinal endometriosis, umbilical endometriosis, ectopic endometriosis, cutaneous endometriosis，关系为“or”。限定检索词在title/abstract中，发表期限为1980年至2012年间，依据纳入及排除标准，筛选出文献共31篇，病例数共441例。用STATA10.0统计软件处理。结果研究对象中，剖宫产术后病例278例，占63.04%（278/441）；经腹子宫全切术后病例44例，占9.98%（44/441）；其他手术或操作后病例33例，占7.48%（33/441）；自发性病例63例，占14.29%（63/441）。平均年龄为32.17岁（95%CI 29.59~34.97岁），Q=4.811，df=10，P=0.903，I2=0。平均无症状期（症状出现与前次手术、操作的间隔时间）为3.95年（95%CI 2.43~6.43年），Q=1.687，df=5，P=0.890，I2=0。平均病灶最大直径为3.30cm（95%CI 2.58~4.22cm），Q=7.791，df=5，P= 0.168，I2=35.82%。主要就诊症状：包块占（93.22±2.11）%（95%CI 88.88%~97.56%），Q= 15.446，df= 26，P=0.949，I2=0；疼痛占（85.73±2.74）%（95%CI 80.07%~91.39%），Q=19.119，df= 25，P= 0.791，I2=0；症状具有月经周期相关性者占（58.59±5.55）%（95%CI 47.19%~70.00%），Q=68.584，df=26，P=0.000，I2=62.09%。结论 AWE最常继发于剖宫产手术后，也可发生与经腹全子宫切除术后、羊膜腔穿刺术后、阑尾切除术后，甚至在没有任何腹部手术、操作史的患者也可发病。前次手术、操作后出现症状有时间间隔。主要症状为腹壁痛性包块，93%的患者有腹壁包块，86%的患者主诉疼痛，只有约1%的患者无上述症状，近40%的患者症状与月经周期不相关，月经周期相关性症状不能作为鉴别诊断的依据。

关键词: 腹壁子宫内膜异位症, Meta分析

Abstract:

Abstract： Objective To discuss the characteristics of abdominal wall endometriosis (AWE). Methods According to the in and out standards,we located studies through the PubMed retrieval.Terms were: abdominal wall endometriosis, extrapelvic endometriosis, scar endometriosis, incisional endometriosis, inguinal endometriosis, umbilical endometriosis, ectopic endometriosis, cutaneous endometriosis, relations as "or";term limited was in the title or abstract;the deadline for publication was from 1980 to 2012.There were 31 studies located including 441 cases.We assessed quality of studies by using STATA10.0 statistical software. Results Cesarean section accounted for 63.04%（278/441cases）,transabdominal hysterectomy 9.98% of cases （44/441cases）,other operations 7.48%（33/441cases）,and spontaneous cases 14.29%

Key words: abdominal wall endometriosis, Meta analysis

中图分类号:

R711.71

吴珍珍，郭钰珍. 腹壁子宫内膜异位症疾病特征Meta分析[J]. 中国实用妇科与产科杂志, DOI: 10.7504/fk2014090119.

WU Zhen-zhen, GUO Yu-zhen.. The characteristics of abdominal wall endometriosis：meta-analysis and literature review.[J]. Acta Metallurgica Sinica, DOI: 10.7504/fk2014090119.

参考文献

［1］   Wolf Y, Haddad R, Werbin N,et al.Endometriosis in abdominal scars: a diagnostic pitfall［J］. Am Surg,1996,62(12):1042-1044.

［2］    Nirula R, Greaney GC. Incisional endometriosis: an underappreciated diagnosis in general surgery［J］.J Am Coll Surg, 2000,190(4):404-407.

［3］    Rani PR, Soundararaghavan S, Rajaram P. Endometriosis in abdominal scars-review of 27 cases［J］. Int J Gynaecol Obstet, 1991,36(3):215-218.

［4］   Honore GM.Extrapelvic endometriosis［J］. Clin Obstet Gynecol, 1999, 42(3):699-711.

［5］   Blanco RG, Parithivel VS, Shah AK,et al. Abdominal wall endometriomas［J］. Am J Surg, 2003, 185(6):596-598．

［6］   Chatterjee SK. Scar endometriosis:a clinicopathologic study of 17cases［J］. Obstet Gynecol,1980,56(1):81-84.

［7］    Michowitz M, Baratz M, Stavorovsky M. Endometriosis of the umbilicus［J］.Dermatologica,1983,167(6):326-330.

［8］    Clausen I, Nielsen KT. Endometriosis in the groin［J］. Int J Gynaecol Obstet,1987,25(6):469-471.

［9］    Wolf GC, Singh KB. Cesarean scar endometriosis: a review［J］. Obstet Gynecol Surv,1989,44(2):89-95.

［10］    Candiani GB, Vercellini P, Fedele L,et al. Inguinal endometriosis: pathogenetic and clinical implications［J］.Obstet Gynecol,1991,78(2):191-194.

［11］   Daye SS, Barone JE, Lincer RM, et al. Pfannenstiel syndrome［J］. Am Surg,1993，59(7):459-460.

［12］    Koger KE, Shatney CH, Hodge K, et al. Surgical scar endometrioma［J］.Surg Gynecol Obstet,1993,177(3):243-246.

［13］   Singh KK, Lessells AM, Adam DJ, et al. Presentation of endometriosis to general surgeons: a 10-year experience［J］. Br J Surg,1995,82(10):1349-1351.

［14］   Xiang Y, Lang J, Wang Y, et al. Abdominal scar endometriosis:report of 28 cases［J］. Chin Med Sci J,1995,10(3):188-190.

［15］    Seydel AS, Sickel JZ, Warner ED, et al. Extrapelvic endometriosis:diagnosis and treatment［J］. Am J Surg,1996,171(2):239.

［16］   Thacher TD, Nwana EJ, Karshima JA. Extrapelvic endometriosis in Nigeria［J］. Int J Gynaecol Obstet,1997,59(1):57-58.

［17］   Liang CC, Liou B, Tsai CC, et al. Scar endometriosis［J］. Int Surg,1998,83(1):69-71.

［18］   Khetan N, Torkington J, Watkin A, et al.Endometriosis: presentation to general surgeons［J］. Ann R Coll Surg Engl,1999,81(4):255-259.

［19］   Patterson GK, Winburn GB. Abdominal wall endometriomas: report of eight cases［J］. Am Surg,1999,65(1):36-39.

［20］   Dwivedi AJ, Agrawal SN, Silva YJ. Abdominal wall endometriomas［J］.Dig Dis Sci,2002,47(2):456-461.

［21］   Scholefield HJ, Sajjad Y, Morgan PR. Cutaneous endometriosis and its association with caesarean section and gynaecological procedures［J］. J Obstet Gynaecol,2002,22(5):553-554.

［22］   Wasfie T, Gomez E, Seon S, et al. Abdominal wall endometrioma after cesarean section: a preventable complication［J］.Int Surg,2002,87(3):175-177.

［23］   Francica G, Giardiello C, Angelone G,et al. Abdominal wall endometriomas near cesarean delivery scars:sonographic and color doppler findings in a series of 12 patients［J］. J Ultrasound Med,2003,22(10):1041-1047.

［24］   Khammash MR, Omari AK, Gasaimeh GR,et al. Abdominal wall endometriosis［J］. An Overlooked Diagnosis Saudi Med J,2003,24(5):523-525.

［25］   Douglas C, Rotimi O. Extragenital endometriosis-a clinicopathological review of a Glasgow hospital experience with case illustrations［J］. J Obstet Gynaecol,2004,24(7):804-808.

［26］   Gunes M, Kayikcioglu F, Ozturkoglu E,et al. Incisional endometriosis after cesarean section, episiotomy and other gynecologic procedures［J］. J Obstet Gynaecol Res,2005,31(5):471-475.

［27］   Pathan SK, Kapila K, Haji BE, et al. Cytomorphological spectrum in scar endometriosis: a study of eight cases. Cytopathology,2005,16(2):94-99.

［28］   Hensen JH, Van Breda VAC, Puylaert JB. Abdominal wall endometriosis: clinical presentation and imaging features with emphasis on sonography［J］.Am J Roentgenol,2006,186(3):616-620.

［29］   Rao R, Devalia H, Zaidi A. Post-caesarean incisional hernia or scar endometrioma? ［J］. Surgeon,2006,4(1):55-56.

［30］   Vintila D, Neacsu CN,Popa P,et al. Abdominal wall endometriosis after gynecologic procedures: an under-appreciated diagnosis in general surgery［J］. Rev Med Chir Soc Med Nat Iasi,2008, 112(2):393-397.

［31］   Leite GK,Carvalho LF,Korkes H,et al. Scar endometrioma following obstetric surgical incisions: retrospective study on 33 cases and review of the literature［J］. Sao Paulo Med J, 2009,127(5):270-277.

［32］   Bektas H, Bilsel Y,Sari YS,et al. Abdominal Wall Endometrioma:a 10-year experience and brief review of the literature［J］. J Surg Res,2010,164(1):e77-81.

［33］   Ozel L, Sagiroglu J,Unal A,et al. Abdominal wall endometriosis in the cesarean section surgical scar: a potential diagnostic pitfall［J］. J Obstet Gynaecol Res, 2012,38(3):526-530.

［34］   乐杰主编．妇产科学［M］．7版．北京：人民卫生出版社，2008：325．

［35］   成宁海，朱兰，郎景和，等．101例腹壁子宫内膜异位症临床分析［J］．生殖医学杂志，2007，16(2)：82-85．

［36］    魏薇，卢丹，张建萍，等．剖宫产术后腹壁子宫内膜异位症手术119例临床分析［J］．现代妇产科进展，2010，19(8)：573-579．

［37］   李小毛，段涛，杨慧霞．剖宫产热点问题解读［M］．北京：人民军医出版社，2008：82-83．

［38］    郎景和.子宫内膜异位症研究的任务与展望［J］.中华妇产科杂志,2006,41(6):289-290.

［39］    黄汉辉，杨丹．腹壁子宫内膜异位症研究进展［J］．复旦学报：医学版，2010，37(1)：116-118．

［40］   Zhao X, Lang J, Leng J, et al. Abdominal wall endometriomas［J］. Int J Gynecol Obstet, 2005, 90(3):218-222.

［41］    韩小燕,郝敏. 腹壁子宫内膜异位症发病相关因素分析［J］. 中国妇产科临床杂志,2012,13(4):294-295.

［42］   Dragoumis K,Mikos T,Zafrakas M,et al. Endometriotic uterocutaneous fistula after cesarean section:a case report［J］.Gynecol Obstet Invest, 2004, 57(2):90-92.

［43］   Raddaoui E，Aweeri S.Abdominal wall endometriosis: a report of 2 cases with primary diagnosis by fine needle aspiration［J］. Acta Cytol， 2010， 54(2): 214-216．

［44］   王飞，龚萍，何钒，等. 腹壁子宫内膜异位症的针吸细胞学诊断［J］．现代医学,2012，40(6): 679-681.

（2014-05-10收稿    2014-07-20修回）

[1]	周萍1，王沂峰2. 宫颈上皮内瘤变锥切术后残留或复发相关因素Meta分析[J]. 中国实用妇科与产科杂志, 2014, 30(7): 546-552.
[2]	陈丹1,于慧会2,史海敏1,张新2. 保留盆腔神经的广泛性子宫切除术治疗宫颈癌疗效及安全性荟萃分析[J]. 中国实用妇科与产科杂志, 2014, 30(11): 882-888.