[Clinical analysis of 244 cases with abdominal wall endometriosis].

Objective: To investigate the clinical characteristics, diagnosis, treatment, outcomes and prognostic factors of abdominal wall endometriosis (AWE). Methods: A total of 265 AWE patients who underwent surgical treatment in The First Affiliated Hospital of Anhui Medical University from January 2010 to April 2023 were retrospectively selected, and 244 patients had complete follow-up data. According to different depth of lesions, the enrolled patients were divided into three types: type Ⅰ (subcutaneous fat layer, n=30), type Ⅱ (anterior sheath muscle layer, n=174) and type Ⅲ (peritoneum layer, n=40). The general clinical features, perioperative conditions, recurrent outcome and prognostic factors were analyzed in three types. Results: (1) Compared with type Ⅲ patients, the age of onset, parity and incidence of pelvic endometriosis were significantly decreased in type Ⅱ patients [(32.0±4.0) vs (30.0±4.6) years, 1.6±0.6 vs 1.4±0.5, 10.0% (4/40) vs 1.7% (3/174), respectively; all P<0.05], while the proportion of patients with transverse incision was significantly increased [37.5% (15/40) vs 67.3% (115/171); P<0.01]. The first symptoms of type Ⅰ and type Ⅱ were mainly palpable mass in the abdominal wall [73.3% (22/30), 63.2% (110/174), respectively], but the first symptom of type Ⅲ was pain in the abdominal wall [55.0% (22/40); all P<0.05]. (2) No matter the results of preoperative B-ultrasound or intraoperative exploration, the lesion diameters of type Ⅰ, type Ⅱ and type Ⅲ showed significant upward trends (all P<0.05). The proportions of lesion diameter≥3 cm in type Ⅱ and type Ⅲ [67.8% (118/174), 80.0% (32/40)] were significantly higher than that in type Ⅰ (all P<0.05). The median operation time and blood loss of type Ⅰ and Ⅱ were significantly lower than those of type Ⅲ (type Ⅰ vs type Ⅲ: 37.5 vs 50.0 minutes, 10 vs 20 ml, all P<0.05; type Ⅱ vs type Ⅲ: 35.0 vs 50.0 minutes, 10 vs 20 ml, all P<0.05). (3) The median follow-up time was 49 months, the overall symptom remission rate was 98.4% (240/244), and the recurrence rate was 7.0% (17/244). There were no significant differences in recurrence rate and recurrence free time among three types (all P>0.05). Multivariate regression analysis showed that the depth, number, diameter of lesions and postoperative adjuvant medication were not significant factors for postoperative recurrence (all P>0.05). Conclusions: The clinical manifestations of type Ⅲ are the most serious, including obvious abdominal pain symptoms, larger lesion diameter, prolonged operation time, increased intraoperative blood loss and increased incidence of pelvic endometriosis. Complete resection of lesions is an effective treatment for AWE, with high symptom remission rate and low recurrence rate. The depth, number, diameter of lesions and postoperative adjuvant medication are not risk factors for recurrence.目的： 探讨不同分型腹壁子宫内膜异位症（AWE）的临床特点、诊治方法、预后结局及预后影响因素。 方法： 选取2010年1月至2023年4月于安徽医科大学第一附属医院接受手术治疗的全部AWE患者共265例，回顾性分析随访资料完整者244例的临床资料。根据病灶深度不同分为Ⅰ型（侵犯皮下脂肪层，n=30）、Ⅱ型（侵犯前鞘肌肉层，n=174）和Ⅲ型（侵犯腹膜层或腹腔内，n=40），分析各型患者的一般临床特征、围手术期情况、复发及预后影响因素。 结果： （1）Ⅱ型患者的发病年龄、产次和盆腔子宫内膜异位症并发率［分别为（30.0±4.6）岁、（1.4±0.5）次、1.7%（3/174）］比Ⅲ型［分别为（32.0±4.0）岁、（1.6±0.6）次、10.0%（4/40）］均明显低，而既往手术腹壁切口的横切口比例明显升高［分别为67.3%（115/171）、37.5%（15/40）］，差异均有统计学意义（P均<0.05）。Ⅰ型和Ⅱ型患者的首发症状以腹壁扪及包块为主［分别为73.3%（22/30）、63.2%（110/174）］，但Ⅲ型以腹壁疼痛为主［55.0%（22/40）］，差异均有统计学意义（P均<0.05）。（2）无论术前B超检查还是术中探查，Ⅰ型、Ⅱ型和Ⅲ型的病灶最大径均呈显著增加趋势（P均<0.05）；Ⅱ型和Ⅲ型中病灶最大径≥3 cm的比例［分别为67.8%（118/174）、80.0%（32/40）］较Ⅰ型均显著升高（P均<0.05）。Ⅰ型和Ⅱ型患者的中位手术时间和术中出血量比Ⅲ型均显著降低（Ⅰ型和Ⅲ型分别为37.5、50.0 min，10、20 ml，P均<0.05；Ⅱ型和Ⅲ型分别为35.0、50.0 min，10、20 ml，P均<0.05）。（3）术后中位随访时间为49个月，症状缓解率达98.4%（240/244），复发率为7.0%（17/244）。3型患者的复发率和无复发时间均无显著差异（P均>0.05）。多因素回归分析显示，AWE分型、病灶数目、病灶最大径及术后辅助用药均不是术后复发的显著影响因素（P均>0.05）。 结论： Ⅲ型AWE的临床表现最严重，包括腹痛症状明显、病灶最大径较大、手术时间延长、术中出血量增加及盆腔子宫内膜异位症并发率升高；完全切除病灶是AWE的有效治疗方法，术后症状缓解率高，复发率较低；AWE分型、病灶数目、病灶最大径及术后是否辅助用药均不是复发的影响因素。.