Endometriosis of the abdominal wall is a specific site of endometriosis, which is a type of endometriosis and is generally considered to be caused by endometrial fragments, which are difficult to detect with the naked eye, scattered in the abdominal wall incision and implanted therein during cesarean section.
I. What is the incidence?
The incidence of abdominal wall endometriosis is on the rise year by year. What are the clinical symptoms of abdominal wall endometriosis? How to treat endometriosis of the abdominal wall? A series of questions followed.
Second, the cause
The cause of abdominal wall endometriosis is generally believed to be endometrial fragments that are difficult to detect with the naked eye and are scattered in the abdominal wall incision and planted therein during cesarean section.
Symptoms
Most of the masses are closely related to menstruation, and the pain increases before and during menstruation, while the pain is relieved and the masses shrink after menstruation. It is accompanied by dysmenorrhea, excessive menstruation, prolonged menstruation, infertility, unpleasant sexual life, cramped stool, bladder symptoms, etc.
Differential diagnosis
For endometriosis of the abdominal wall with atypical symptoms, it is necessary to differentiate it from other diseases before surgery, including incisional nodules, incisional suture granulation tissue, incisional hernia, abscess, hematoma, abdominal wall tumor, etc.
In addition to palpation examination by the surgeon through both hands, ultrasonography is simpler and non-invasive to apply and can measure the size of the lesion, the depth of invasion and infiltration, and the relationship between the lesion and the surrounding tissue structures. CT and MRI can also be used for preoperative evaluation and are usually used when the lesion is large, or the invasion is deep, or when malignant changes are suspected.
V. Hazards
1. Female infertility: 40%-50% of endometriosis. Endometriosis can cause pelvic adhesions, tubal hardening or even obstruction, abnormal metabolic function of hormones and abnormal immune function, resulting in retrograde migration of the pregnant egg and endometrium asynchronously, or causing infertility due to retrograde obstruction of the pregnant egg itself.
2. Menstrual disorders: Invasion by ectopic endometrium destroys the ovarian parenchyma and affects hormone metabolism, resulting in menstrual disorders and increased vaginal bleeding during menstruation, as well as individual premenstrual spotting bleeding.
3, painful intercourse: the ectopic endometrium swells the surrounding tissues and causes pain during intercourse due to the influence of penile jerking, which is more obvious in the premenstrual period.
4, ovarian tumors: ovaries are the favorite place for ectopic endometrium to “live”, whenever menstruation comes, menstrual blood will always be stored in the ovaries, and more and more will be stored, slowly the mass will be formed unknowingly.
5, ectopic pregnancy (ectopic pregnancy): ectopic endometrium can cause pelvic adhesions, tubal dysfunction, and fertilized eggs can only develop locally, leading to an increased probability of ectopic pregnancy.
VI. Where is the site of onset
The incidence of abdominal wall endometriosis is 0.03%~0.40%, which is generally believed to be caused by endometrial fragments, which are difficult to detect with the naked eye, scattered in the abdominal wall incision and planted in it during the cesarean section. The clinical symptoms are The clinical symptoms are hard nodules or masses at the abdominal wall incision, most of which are closely related to menstruation, increasing in size and pain before and during menstruation, and relieving pain and reducing in size after menstruation. Ultrasonography can help in the diagnosis.
VII. Disease prevention
Breastfeeding can prevent the occurrence of endometriosis in the abdominal wall. Endometriosis is a hormone-dependent disease affected by the endocrine secretion of the body, and the estrogen level in the body decreases rapidly after delivery. Breastfeeding can make the ovarian function recover slowly and the estrogen level recover slowly, which is not conducive to the growth of endometrium that may be scattered in the incision, and can make the endometrium shrink and avoid the occurrence of endometriosis.
VIII. How to treat
There are various treatment methods for abdominal wall endometriosis, including medication and surgery, and the choice of which method should be considered according to the specific situation of the patient. Gynecologic endometriosis is a disease caused by the growth of active endometrium in a location other than the inner wall of the uterine cavity.
The most frequent sites are the ovaries, uterus, uterosacral ligament, and pelvic peritoneum. The age of predilection is 26-40 years old women. Western medicine believes that the cause of abdominal wall endometriosis is not completely clear, and it is more commonly believed that there are endometrial implantation theory, lymphatic and venous dissemination theory, body cavity epithelial metaplasia theory, immune theory, and genetic factors. According to traditional Chinese medicine, the main cause of this disease is blood stasis, either due to qi stagnation, cold condensation, heat depression, qi deficiency, or kidney deficiency, resulting in blood leaving the menstruum and stagnation of blood. Endometriosis of the abdominal wall is diverse depending on where it grows. Common symptoms include dysmenorrhea, infertility, painful intercourse, menstrual irregularities, menstrual fever, cyclic rectal irritation, cyclic bladder irritation, acute abdominal symptoms during or around menstruation, and cyclic lower abdominal discomfort. The symptoms do not subside until menopause when the ovarian symptoms fail.
Drug treatment for abdominal wall endometriosis mainly involves the application of sex hormone drugs to inhibit the proliferation of ectopic endometriosis and to induce atrophy and degeneration of the endometrium of the ectopic uterus; surgical treatment mainly involves the surgical removal of the ectopic endometrium and local diseased tissues to restore the normal structural position of the tissues and organs and to achieve the purpose of getting rid of pain and discomfort as well as restoring fertility function. There are various surgical procedures available for different types of patients.
In addition, surgical treatment of endometriosis of the abdominal wall can be combined with pharmacological treatment to improve the therapeutic effect, and in individual cases, surgical treatment becomes necessary, although pharmacological treatment must still be considered after surgery to reduce the chance of recurrence.
This disease is not a simple stagnation of qi and blood, but a combination of deficiency and actuality, with the deficiency in the spleen and kidney and the stagnation of qi and blood in the symptoms, so the treatment of Wun Gong Nei Yi Tang adopts the method of treating both symptoms and actuality.
Nine, postoperative attention things
1, pay attention to adjust their emotions, maintain an optimistic and cheerful state of mind, so that the function of the body’s immune system is normal.
2, to pay attention to their own warmth, avoid feeling cold.
3, during menstruation, prohibit all strenuous sports and heavy physical labor.
4. If you are found to be suffering from endometriosis and ovarian chocolate cysts larger than 6cm, you should pay attention to maintain emotional stability during menstruation or the middle of menstruation and avoid overexertion. Once the tension in the cyst cavity suddenly rises, the cyst wall will rupture and form an acute abdomen.
5. Try to do abortion and scraping as little as possible, and do family planning.
6, the menstrual period to do a good job of their own health care, pay attention to control their emotions, do not sulk, otherwise it will lead to endocrine changes.
7, girls should avoid fright during puberty, so as not to lead to amenorrhea or the formation of overflow.
8, women must stop having sex during menstruation.