关键词: 子宫内膜异位症, 腹壁, 筋膜缺损, 补片, 手术, 剖宫产

Abstract: Objective：To explore and compare the clinical and sonographic characteristics of grouped patients with abdominal wall endometriosis（AWE） in terms of whether use mesh or not to repair the fascia defect when wide excision was done，and to find reliable indicators of preoperative prediction. Methods：161 cases of pathologically proved AWE with history of transverse incisional cesarean section during 6-year period（2005—2010）in the department of Obstetrics and Gynecology of Peking Union Medical University Hospital（Beijing，China） were analyzed retrospectively. Patients were divided into two groups according to whether the mesh was needed to repair the fascia defect. Clinical and ultrasound（US）findings were compared between them. Prediction formula and single-index threshold were obtained by Logistic′s regression analysis and ROC curve method respectively. The similar surgical cases of 49 patients admitted in 2011 were used to test accuracy and feasibility of two methods prospectively as previously mentioned. Results：Compared with simple excision group， patients who needed artificial mesh to repair abdominal wall had larger size of foci（3.9 cm vs. 2.5 cm，P=0.001）; more vascular signals by US（41.7% vs. 27.9%，P=0.038）；higher level of serum CA125 means（48.6 U/mL vs. 32.2 U/mL，P=0.041）；more chance of entering intra- abdominal cavity（79.4% vs. 18.9%，P=0.000）；larger fascia defect（6.4 cm vs. 1.6 cm，P=0.000）；more perioperative bleeding（73.1 mL vs. 29.5 mL，P=0.000）; higher frequency of using incisional drainage（76.7% vs. 9.0%， P=0.000）; and longer hospital stays（10.2 d vs. 6.4 d，P=0.000）. In terms of mean age，time since onset of symptoms，character of pain，number and margin of foci， there is no significant difference between two groups. The threshold of maximal diameter by US was 3 cm by ROC curve. Logistic′s regression formula was P（mesh）=1/［1+e-（-3.141+0.408max diameter of foci by US+0.019 serumCA125）］. The predictive outcomes of 49 cases were compared with surgical outcomes. The overall compliance rate were 81.6% and 91.3% respectively，which underestimated rate were 7.7% and 27.3%，overestimate rate were 22.2% and 2.9% respectively. Conclusions：The longest diameter of ultrasound lesion has good predictive value of discriminating fascia defect and use of mesh，with 3 cm as warning value. The Logistic regression formula with serum CA125 involved in，does not significantly improve the prediction performance. For positive predicted patients，it is recommended to strengthen counseling and a full range of preparations.

Key words: Endometriosis, Abdominal wall, Fascia defect, Mesh, Surgery, Cesarean section