Analysis of clinical factors in endometriosis of the abdominal wall

Analysis of clinical factors in endometriosis of the abdominal wall | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Analysis of clinical factors in endometriosis of the abdominal wall Qiucheng Jia, Huimin Tang, Wanying Chen, Weiwei Wei, Hong Zheng, and 2 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-4558292/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 22 Mar, 2025 Read the published version in BMC Women's Health → Version 1 posted 10 You are reading this latest preprint version Abstract Objective To analyse and summarise the clinical characteristics, diagnosis, treatment and prognostic features of abdominal wall endometriosis. Methods A retrospective analysis of patients with abdominal wall endometriosis who attended Changzhou Second Hospital of Nanjing Medical University from January 2013 to December 2022 was performed. They were grouped according to the depth of infiltration of the lesion and the direction of incision, and the differences between the groups were compared. Results A total of 228 patients with abdominal wall endometriosis were included in this study, including 210 cases with a history of abdominal transverse incision surgery, 16 cases with a history of vertical incision surgery, 1 case with a history of uterine fibroids surgery, 1 case with primary abdominal endometriosis, and 178 cases with the primary symptom of cyclic pain. They were classified as solitary and complex according to the number of lesions. Both were statistically significant for BMI, number of caesarean sections, operative time, bleeding and postoperative hospital stay (p<0.05). According to the depth of infiltration, they were divided into fascial, rectus abdominis and peritoneal types. There were differences between the three in latency time, CA125, maximum diameter of the lesion, operation time, bleeding and postoperative hospital stay (p0.05). On imaging, magnetic resonance imaging was more accurate for lesion typing. Conclusion AWE should be diagnosed early and treated surgically. The clinical manifestations of the same type are different, and CA125 test and abdominal wall ultrasound can be used preoperatively to determine lesion typing. Nuclear magnetic resonance (NMR) may be used to improve preoperative preparation for difficult diagnosis or staging. Abdominal wall endometriosis surgery lesion typing Figures Figure 1 Introduction Endometriosis refers to the location of the glands and mesenchyme of the endometrium outside the uterine lining, accompanied by cyclical pain during menstruation, and is one of the most common gynaecological endocrine disorders, affecting approximately 5-10% of women [1] . The most common site of endometriosis is the pelvis, with the ovaries and the vaginal-rectal fossa being the most common sites. It is less common to find endometriosis outside the pelvis, with abdominal wall endometriosis being the most common, with a prevalence of about 0.03%-3.5% according to relevant studies [2] . Abdominal wall endometriosis (AWE) refers to the infiltration of endometrial glands and mesenchyme into the abdominal wall, mostly secondary to a history of gynaecological surgery such as caesarean section, uterine and ovarian surgery. With the recent increase in the caesarean section rate, the incidence of AWE has gradually increased, and the variability of its clinical manifestations, time of occurrence and other disease characteristics has gradually increased, making it difficult to distinguish from some diseases such as lipoma, haematoma, granuloma and other diseases. In addition, there are fewer research reports on the diagnosis and treatment of AWE both domestically and internationally. In this paper, by collecting and analysing the clinical data of abdominal wall endometriosis in our hospital from 2013 to 2022, we summarise the aetiology, clinical characteristics, treatment and prognosis of abdominal wall endometriosis, hoping to provide new ideas for the clinical diagnosis and treatment of abdominal wall endometriosis. 1. Information and methodology 1.1. Source of information A total of 228 patients with abdominal wall endometriosis who attended Changzhou Second People's Hospital affiliated with Nanjing Medical University from January 2013 to December 2022 were collected, and all of them underwent resection for abdominal wall lesions in our hospital after excluding contraindications to surgery, and postoperative pathology suggested abdominal wall endometriosis. Complete clinical and follow-up data are available. 1.2. Clinical information collection Patients' age, number of pregnancies and births, number of caesarean sections, latency period, surgical history, BMI, CA125, lactate dehydrogenase, alkaline phosphatase, imaging, operation time, bleeding and hospital stay were recorded. We divided the patients into three groups according to the depth of invasion of the lesion: fascial (invasion of subcutaneous fat or superficial fascia), rectus abdominis (lesion invasion of the anterior sheath or muscle), and peritoneal (lesion invasion of the peritoneum) [3] . Based on whether the lesion was solitary or not, we classified patients into simple and complex types. 1.3.Statistical methods SPSS 26.0 statistical software was used, and measures conforming to normal distribution were described by X±S, and the t-test was used for two groups of data. Multi-group data were tested using the ANOVA test: measures not conforming to normal distribution were described as the median (P25-P75). The Mann-Whitney U test was used for two groups of data and the Kruskal-Wallis test for multiple groups of data. Relationships between the two variables were analysed using linear regression correlation analysis, the Person chi-square test for unordered categorical variables, and ROC curves in the predictive model. p<0.05 was considered a statistically significant difference. 2. Result 2.1. General Patient Situation The mean age of onset was 32.7±4.2 years (23-51 years) in 228 patients with abdominal wall endometriosis.Of these, 226 (99.1%) had a history of previous caesarean section and 153 (67.7%) underwent a single caesarean section.The surgical scar was a transverse abdominal wall incision in 210 patients (92. The surgical scar was a transverse incision of the abdominal wall in 210 patients (92.9%) and a vertical incision of the abdominal wall in 16 (7.1%).In the remaining two cases, one patient had primary abdominal wall endometriosis, one patient had an abdominal wall incision and the other patient had primary abdominal wall endometriosis. Of the remaining two patients, one had previous surgery for leiomyoma and one had primary abdominal wall heterotaxy.Pain in the abdominal wall scar during cyclic menstruation was the first clinical manifestation in 113 patients (77.9%).A palpable abdominal wall mass was the first symptom in 40 patients (17.5%). Heterotopic foci in the original surgical scar were found at caesarean section in 7 patients (3.4%).Pale bloody discharge from the abdominal wall during menstruation was the first symptom in 1 patient.A surgical scar in the abdominal wall was the first symptom in the remaining 2 patients. effusion as the first symptom.2 cases were due to the discovery of ectopic foci in the abdominal wall during ovarian surgery (see Table 1 for details). 2.2. Data comparison 2.2.1. Comparison of general information on single-type lesions and multiple-type lesions The total number of solitary type lesions was 188 (82.5%) and the difference in BMI, operative time, intraoperative bleeding and postoperative hospital stay was statistically significant (p<0.05) compared to complex type patients. That is, complex patients had lower body weight, longer operation time, more bleeding and longer postoperative hospital stay. There was no statistically significant difference (p>0.05) in age, latency, duration of symptoms, CA125, LDH, ALP, PT, FIB and maximum lesion diameter. We found that the number of caesarean sections was lower in patients with multifocal lesions than in those with solitary lesions, and the difference was statistically significant. However, related studies concluded that the number of caesarean sections and the number of lesions did not have a significant relationship, so larger data are needed to prove this further [6]. See Table 2 for details. 2.2.2. Comparison of general information on different lesion types Based on the depth of infiltration of the lesions, abdominal wall endometriosis was classified into fascial, rectus abdominis and peritoneal types. There was no statistically significant difference between these three types in terms of age, BMI, number of caesarean sections, duration of symptoms, LDH, ALP, PT and FIB (p>0.05). Patients with the peritoneal type had a longer incubation period, a larger maximum diameter of the lesion, a higher CA125 level and a longer operative time, bleeding and postoperative hospital stay compared to the other two types. The difference was statistically significant (p<0.05).See Table 3 for details. 2.2.3. Comparison of information on different incision types Approximately 173 cases of transverse incision caesarean section were of the simple type and 37 cases were of the complex type. Among the patients with vertical incision caesarean section, there were 15 cases of simple type and 6 cases of complicated type. The difference between the two comparisons was not statistically significant (see Table 4 for details). The likelihood of the lesion being on the right side was slightly higher in the transverse incision than on the left side (see Table 5 for details). 2.2.4. Linear regression relationship between lesion diameter and clinical indicators The maximum diameter of the lesion was related to the duration of surgery, the amount of bleeding, the duration of postoperative hospitalisation, the incubation period, CA125 and the type of lesion (see Table 6 for details). And all of them showed a linear relationship (see Figure 1), suggesting that the deeper the infiltration depth of the lesion, the longer the incubation period, and the larger the lesion at the time of appearance of clinical symptoms. 2.2.5. Imaging 218 patients underwent preoperative ultrasound examination of the abdominal wall, and 17 of them were also given MRI examination. By comparing the ultrasound, surgical and MRI data, we found that there was no significant difference between the three in determining the maximum diameter of the lesion and whether the lesions were multiple (p>0.05). In determining the depth of the lesions, nuclear magnetic resonance was more accurate than ultrasound (p<0.05)(see Table 7 for details). 2.2.6. Anticipate We used ROC curve for combined ultrasound and CA125 for prediction of peritoneal versus non-peritoneal lesions. The cut-off value was 25.27 U/ml,at which point the sensitivity was 88.9%, the specificity 97.6% and the Yoden index 0.865. 2.3. Drug therapy, prognosis and relapse Eight patients were treated conservatively with GnRH-a medication prior to surgery, and after 3 courses of treatment, the size of the abdominal wall lesions decreased compared to the size before medication, with no significant improvement in symptoms. Symptoms worsened after stopping the medication and all were admitted to hospital for surgical treatment. All surgical patients were not treated with medication after surgery, and at postoperative follow-up (11-131 months), except for 49 patients who were lost to follow-up, 6 of 179 patients (3.4%) had a recurrence. Of these, 4 cases were treated with surgery in an outside hospital, 1 case was not treated due to minor symptoms, and 1 case was treated conservatively with medication. 3. Discussion Abdominal wall endometriosis is one of the rarest forms of endometriosis and most cases are seen after a caesarean section or pelvic surgery with endometrial implantation in the abdominal wall. In this study, we collected 228 cases treated over the last 10 years to gather relevant clinical data to help us better understand this type of disease. The mechanism of endometriosis formation in the abdominal wall is not clear, and there are theories of local implantation, epithelial metaplasia, lymphatic or blood dissemination [4] . Among these, the local implantation doctrine proposed by Sampson et al. is now widely accepted in clinical practice. This doctrine suggests that when patients with AWE undergo caesarean section or other uterine surgery, the endothelial tissue is implanted into the abdominal wall wounds, causing a local focal inflammatory response with hormonal fluctuations. 99.6% of patients in this study had a history of related surgery, which is consistent with the study by Zhang et al [5, 6, 7] and in line with this type of teaching. In patients with primary AWE, epithelial hyperplasia, lymphatic or blood dissemination would then better explain its formation. The typical triad of AWE: history of previous caesarean section, localised abdominal mass and cyclical pain [8] . Recent clinical studies have confirmed caesarean section as an independent risk factor for AWE [9] . In this study, 99.1% of patients had a history of caesarean section, 178 patients (78.1%) had their first symptom of cyclical pain, and 40 patients (17.5%) had their first symptom of abdominal wall mass. Not all patients with AWE had this symptom, one patient in our collection was admitted for menstrual fluid discharge from a primary abdominal wall wound and nine were asymptomatic due to other intraoperative findings. The size of the local abdominal mass may increase with the menstrual cycle, and the local skin colour has changed to dark red in some patients [8] . Symptoms are different when the lesion is in different locations. Depending on the depth of infiltration, they are classified as fascial, rectus abdominis and peritoneal. The first two are more common in the clinic and their clinical manifestations are more obvious. Patients with the peritoneal type often present with localised wound discomfort because the lesion is in a deeper location. In addition, this study found that the incubation period of this type was also longer than the previous two, which is also consistent with the study by Jiang et al [10] . In addition to the general physical examination, imaging is one of the most important modalities used clinically to diagnose AWE. Recent studies suggest that the diagnostic accuracy of abdominal ultrasound in AWE is 73.2% to 96.3% [11] . In this case, a total of 218 patients underwent preoperative abdominal ultrasound, and all were consistent with postoperative pathology. Ultrasound can clearly delineate the border between the lesion and the surrounding tissue, and blood flow visualisation can show striated or punctate blood flow in or around the lesion [12] . It is also widely used for preoperative diagnosis because it is convenient, non-invasive and inexpensive. However, it is difficult to diagnose the extent and depth of lesion involvement using ultrasound. In this study, we compared the lesion with ultrasound and nuclear magnetic resonance (NMR) and found that NMR had better accuracy. In addition, when ultrasound cannot clearly diagnose the type of lesion, MRI is more advantageous [13] . Laboratory tests consist mainly of tumour indicators such as CA125 levels. It is currently not considered clinically specific for the diagnosis of abdominal wall endometriosis. In this study, CA125 was compared according to the depth of infiltration of the lesion, and the three were found to be statistically significant. The CA125 levels in patients with the peritoneal type were significantly higher than the other two types. We analysed that this might be related to the longer incubation period of the peritoneal type and the large diameter of the lesion and the extent of infiltration, which is consistent with the study by Li et al. [7] However, in this study, we compared the simple lesion and the complex type lesion and found that there was no significant difference between the two. Therefore, we believe that CA125 is necessary for preoperative examination and can be used as one of the reference indices for clinical lesion typing. However, its accuracy still needs to be proven by a large amount of data and research. The main treatments for AWE are medication, surgery and high-intensity focused ultrasound [3] .Pharmacological treatment includes progestins, short-acting contraceptives and gonadotropin-releasing hormone analogues. Pharmacological treatment is usually ineffective because the lesion is encapsulated by connective tissue. Long-term treatment with this type of hormonal medication has adverse effects on the body, and symptoms usually worsen when the medication is stopped. In this trial, eight patients were treated conservatively with GnRH-a, but the results were poor. Therefore, in clinical practice, conservative treatment with medication is usually reserved for patients with contraindications to surgery. Surgery is the most important way to prevent recurrence of AWE, and whether or not the lesion can be completely removed during surgery largely determines whether or not AWE will recur. Surgery is usually performed through an incision in the original abdominal wall, and an ultrasonic knife is used to make a complete resection along the edge of the lesion of 0.5-1 cm, and the existing scar on the abdominal wall should also be removed. For large infiltrating lesions, such as rectus abdominis or peritoneal lesions, placement of a drain after surgery may be considered to aid wound healing. For large, high-tensile lesions that are difficult to suture, we generally use intraoperative patch placement to cover the defect, reduce local tension and beautify the wound. In this study, four patients with peritoneal lesions >5 cm in diameter received intraoperative patches and postoperative negative pressure drainage, and the wounds healed well [14] . The maximum diameter of intraoperative peritoneal lesions was found to be significantly larger than the other two types. We believe that this may be due to its deeper location, longer latency period and richer peritoneal blood supply. In addition, operative time, intraoperative bleeding and postoperative hospital stay were statistically significant for this type. Therefore, patients with peritoneal abdominal wall endometriosis should be better prepared for surgery and the lesions should be more carefully isolated and removed during surgery. Regarding the use of postoperative medication as a preventive measure, studies have shown that this treatment does not reduce the recurrence rate [15, 16, 17] . In this paper, 228 patients were not treated with postoperative prophylaxis and the recurrence rate after surgery was only 3.4%. High-intensity focused ultrasound is a new clinical tool currently used to treat AWE, in which low-intensity ultrasound waves from outside the body are focused on the lesion area of the abdominal wall to produce local coagulation-like necrosis. This treatment option has now been shown to be superior to traditional surgical methods in terms of operating time and bleeding. However, it can cause some damage to the surrounding tissues and has narrow indications, and the current clinical trial is relatively small, which requires further research [18] . To prevent AWE, the clinic should first control the rate of caesarean section and the indication for surgery. Use of isolation measures during surgery, such as placing sterile gauze or incision protectors over the wound. Repeated irrigation of the pelvis and wound after suturing the uterus to avoid local endothelial implantation. Avoid using the same suture when suturing the uterine incision and other tissues etc [19,20] .AWE is most common in fascial and rectus abdominis types and occurs on both sides of the wound. It may be related to the limitations of the operation, resulting in the ease of implantation of endothelial tissue compared to other sites. Therefore, repeated irrigation prior to closure of the abdomen to release only the fascial layer appears to be important. It has been suggested that by comparing cesarean transverse incision with straight incision, it was found that the latency period of straight incision is longer than transverse incision and it was suggested that straight incision in cesarean section is better than transverse incision for prevention of AWE [5] . In the present study, the latency period was compared between the two, 3.6±2.02 years for straight incision and 3.5±2.33 years for transverse incision and found to be statistically insignificant (p>0.05). It was therefore concluded that the two approaches did not increase the likelihood of AWE. However, a large amount of data is still needed for further studies. In conclusion, with the increase of caesarean section rate in recent years, the incidence of AWE has also gradually increased, so we do a good job in intraoperative tumour-free defence measures. In the face of clinical history of uterine surgery, abdominal wall mass and cyclical pain patients should be highly suspected of AWE, in perfect ultrasound and CA125 and other auxiliary examination, early surgical treatment to avoid further increase in the diameter of the lesion. For patients with complex lesions, relevant imaging should be perfected preoperatively, and intraoperative exploration should be carefully carried out to resect possible lesions to avoid postoperative remnants leading to recurrence and secondary surgery. In patients with abdominal wall endometriosis, postoperative medical treatment has no effect on recurrence. Therefore, preoperative and postoperative medication should be fully considered. The study sample in this paper is relatively small and the conclusions need to be confirmed by a large amount of data. Declarations Declaration of interests The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper. Funding details Changzhou Municipal Health Commission Science and Technology Project (ZD202314); Changzhou "14th Five-Year Plan" High-level Talent Cultivation Project (2022CZBJ074); Jiangsu Province Maternal and Child Health Key Talent Project (RC202101); Jiangsu Province Maternal and Child Health Scientific Research Project (F202138). Postdoctoral Research Support Programme of Jiangsu Province (2019K064); Jiangsu Province "333 Project" Research Support Programme (BRA2019161). Availability of data and materials The data supporting the conclusions of this article is available from corresponding author. Informed Consent Statement Informed consent was obtained from all subjects involved in the study. Trial registration The study was conducted in accordance with the Declaration of Helsinki. Ethics declaration This was a retrospective tiger study and ethical approval was obtained from the Ethics Committee of Changzhou Second People's Hospital affiliated with Nanjing Medical University. 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Tumour-free defence issues in caesarean section - prevention of endometriosis in the abdominal wall[J]. Chinese Journal of Practical Gynaecology and Obstetrics,2023,39(01):31-34.DOI:10.19538/j.fk2023010110. Poismans G, Tolbize N, Gielen F, Lipombi D. PRÉVENTION DE L'ENDOMÉTRIOSE PARIÉTALE POST-CÉSARIENNE [POST-CAESAREAN ABDOMINAL WALL ENDOMETRIOSIS PREVENTION]. Rev Med Liege. 2016;71(4):193-197. Tables Table 1 General information on the condition of patients with internal heterotaxy of the abdominal wall Features n（%） X±S (range) Age (years) 32.7±4.2（23-51） BMI（kg/m²） 22.75±3.65（16.9-38.2） CA125 27.28±20.45 LDH 154.74±23.14 ALP 60.79±18.18 FIB 2.82±1.67 PT 11.37±0.62 Number of caesarean sections 1 (case) 153（67.7%） ≥2 (cases) 73（32.3%） Cesarean section incision Transverse incision 210（92.9%） Vertical incision 16（7.1%） Incubation period (years) 3.59±2.04（1-9） Symptoms to surgery (years) 0.96±0.65 Clinical manifestation Cycle pain (cases) 178（78.1%） Abdominal masses (cases) 40（17.5%） Other symptoms (cases) 10（4.4%） Lesion depth Fascia type (cases) 99（43.4%） Rectus abdominis (case) 108（47.4%） Peritoneal type (cases) 21（9.2%） Focus of infection Single hair type (case) 188（82.5%） Complex type (cases) 40（17.5%） Imaging Ultrasound (cases) 218（95.6%） MRI (cases) 17（7.5%） Curing Preoperative drug treatment (cases) 8（3.5%） Surgical treatment (cases) 228（100%） Intraoperative mesh (cases) 4（1.8%） Postoperative medication (cases) 0% Table 2 Comparison of patient data for solitary versus complicated abdominal wall endometriosis (using Mann-Whitney U test; one-way ANOVA) Lesion type Single-incidence type (188 cases) Complex (40 cases) Statistic P Age (years) 32.81±4.31 32.30±3.79 F=0.239 0.626 BMI 22.58 （20.8-24.98） 20.99（19.63-22.41） Z=-2.543 0.011 Number of caesarean sections 1.37±0.508 1.11±0.315 Z=-2.184 0.029 Incubation period (years) 3 （2-5） 4（2-5） Z=-0.683 0.495 Persistence of symptoms (years) 1 （0-1） 1（0-2） Z=-1.463 0.143 CA125 20.75 (13.83-31.64) 25.57 (19.34-40.59) Z=-1.704 0.088 LDH 152 （139-168） 147.45（139.85-162.5） Z=-0.683 0.567 ALP 57.7 （50-69） 55.2 （47.95-67.9） Z=-0.349 0.727 PT 11.3 （10.9-11.7） 2.66 （2.31-3.02） Z=-1.218 0.223 FIB 2.52 （2.31-2.96） 2.66 （2.31-3.02） Z=-0.936 0.350 Maximum diameter of lesion (cm) 2.5 （2-3） 2.9 （2.0-4.0） Z=-1.778 0.075 Surgical time (min) 30 （20-45） 52.5 （31.25-75） Z=-3.545 <0.01 Bleeding volume (ml) 5 （5-10） 10 （5-10） Z=-2.558 0.011 Post-operative hospitalisation (days) 4 （3-4） 4.5 （4-5） Z=-4.109 <0.01 Table 3 Comparison of general data of patients with different lesion types (Kruskal-Wallis test; one-way ANOVA) Lesion type Fascial type Rectus abdominis type Peritoneal Statistic P Age (years) 32.41±3.86 32.80±4.82 33.73±2.05 F=0.454 0.636 BMI 22.21 21.91 21.83 χ2 =0.362 0.834 Number of caesarean sections 1.39±0.492 1.28±0.455 1.27±0.647 χ2 =1.911 0.385 Incubation period (years) 3 （2-4.5） 3 （2-5） 4 （4-6） χ2 =4.757 0.045 Persistence of symptoms (years) 1 （0-1） 0.5 （0-1） 2 （1-2） χ2 =6.196 0.093 CA125 14.75（11.31-25.86） 25.57（18.85-37.7） 35.96（19.87-62.60） χ2 =21.209 0.000 LDH 153（142-167.75） 149（138.2-168） 144.15（137.1-168.2） χ2 =1.647 0.439 ALP 57.85（53.08-70.08） 55 （45.9-68） 55.2（44.73-62.9） χ2 =1.677 0.432 PT 11.3 （10.9-11.7） 11.4（11.1-11.7） 11.45（10.93-11.55） χ2 =0.227 0.893 FIB 2.52 （2.27-3.02） 2.29（2.34-2.95） 2.57 （2.3-3.05） χ2 =0.025 0.987 Maximum diameter of lesion (cm) 2.0 （1.65-3.0） 2.5（2.0-3.125） 3.0 （2.5-4.0） χ2 =10.395 0.006 Surgical time (min) 30 （17.5-45） 35 （25-50） 55 （30-75） χ2 =9.522 0.009 Bleeding volume (ml) 5 （5-10） 5 （5-10） 10 （5-10） χ2 =6.824 0.033 Post-operative hospitalisation (days) 3 （3-3） 4 （4-4） 5 （5-6） χ2 =56.649 <0.01 Table 4 Effect of cesarean section incision orientation on lesion type (Person's chi-square test) Direction of incision Number of examples Floppy Complex type Chi-square value P Transverse incision 210 173（82.4%） 37（17.6%） 1.374 0.241 Vertical incision 16 15 （93.8%） 1 （6.2%） Table 5 Location of lesions at different incisions Direction of incision Lesion location Counting Transverse incision total 210（100%） left side 92（43.8%） interlocutory 4（1.9%） right side 114（54.3%） Vertical incision (grand) total 16（100%） top 4（25%） interlocutory 4（25%） bottom 8（50%） Table 6 Linear regression relationship between lesion size and general patient information Lesion size Post-operative length of stay Intraoperative bleeding Surgical time CA125 Incubation period Age Type of lesion R² 0.1718 0.1224 0.2571 0.092 0.06455 0.04178 0.0806 P-value 0.00 0.00 0.00 0.003 0.007 0.0292 0.002 Table 7 Comparison of imaging general patient data General information Ultrasound Nuclear magnetic resonance (NMR) Surgeries P Maximum lesion diameter (cm) 2.43±1.11 2.53±1.07 2.4±1.16 0.961 Lesion depth 0.02 Fascial type (cases) 6（23.5%） 1（5.9%） 2（11.8%） Rectus abdominis muscle (cases) 10（70.6%） 10（58.8%） 10（58.8%） Peritoneal type (cases) 1（5.9%） 6（35.3%） 5（29.4%） Number of lesions 0.382 Single-shot 15（88.2%） 12（70.6%） 12（70.6%） Frequent 2（11.8%） 5（29.4%） 5（29.4%） Additional Declarations No competing interests reported. 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Changzhou Second People's Hospital of Nanjing Medical University","correspondingAuthor":false,"prefix":"","firstName":"Huimin","middleName":"","lastName":"Tang","suffix":""},{"id":317933155,"identity":"1809aa96-8e88-44aa-a11e-509f93b02ad5","order_by":2,"name":"Wanying Chen","email":"","orcid":"","institution":"The Affiliated Changzhou Second People's Hospital of Nanjing Medical University","correspondingAuthor":false,"prefix":"","firstName":"Wanying","middleName":"","lastName":"Chen","suffix":""},{"id":317933156,"identity":"1bb93baa-cffb-452d-8af0-94e99c5924a4","order_by":3,"name":"Weiwei Wei","email":"","orcid":"","institution":"The Affiliated Changzhou Second People's Hospital of Nanjing Medical University","correspondingAuthor":false,"prefix":"","firstName":"Weiwei","middleName":"","lastName":"Wei","suffix":""},{"id":317933157,"identity":"4b00c5f7-08e0-4cd5-baed-8a04df8bfd3e","order_by":4,"name":"Hong Zheng","email":"","orcid":"","institution":"The Affiliated Changzhou Second People's Hospital of Nanjing Medical University","correspondingAuthor":false,"prefix":"","firstName":"Hong","middleName":"","lastName":"Zheng","suffix":""},{"id":317933158,"identity":"fed2ab62-75ef-4bd8-842e-3890e8afbbc0","order_by":5,"name":"Arong Liu","email":"","orcid":"","institution":"2.Xi'an Yanliang District Fenghuang Road Community Health Service Center,Xi'an 710000,Shanxi Province, PR China","correspondingAuthor":false,"prefix":"","firstName":"Arong","middleName":"","lastName":"Liu","suffix":""},{"id":317933163,"identity":"81d975d0-ea90-4419-9069-36b7dc0894c4","order_by":6,"name":"Jiming Chen","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAArElEQVRIiWNgGAWjYFCCA0DIYMPDz95AmpY0GcmeA6RZddjG4IYDkWr5G08nHi74dZ6H4QYD44ePOURokThwdsPhmX23eRhnNzBLztxGhBYDBqAW3p7bPMwyB9iYeUnQco6HTSKBFC08Pw7w8BCtBewX3oZkHgmeg83E+YV/xtnNn3n+2NnbH28++OEjMVqA1jAwMLaBWIwNxKgHWQNS+IdIxaNgFIyCUTAyAQChZTvL1QqUuQAAAABJRU5ErkJggg==","orcid":"","institution":"The Affiliated Changzhou Second People's Hospital of Nanjing Medical University","correspondingAuthor":true,"prefix":"","firstName":"Jiming","middleName":"","lastName":"Chen","suffix":""}],"badges":[],"createdAt":"2024-06-10 13:20:56","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-4558292/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-4558292/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1186/s12905-025-03660-z","type":"published","date":"2025-03-22T15:57:35+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":59435539,"identity":"728cea72-0884-4636-95f6-9296f6e962fc","added_by":"auto","created_at":"2024-07-01 19:10:52","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":111087,"visible":true,"origin":"","legend":"\u003cp\u003eLinear regression of lesion size with post-operative length of stay,intraoperative bleeding,surgical time,CA125,incubation period and age\u003c/p\u003e","description":"","filename":"floatimage1.png","url":"https://assets-eu.researchsquare.com/files/rs-4558292/v1/c753915bc4a4a196843ce9c2.png"},{"id":79120463,"identity":"2ebeae9f-3ed4-498d-90c4-408c4b95a3ec","added_by":"auto","created_at":"2025-03-24 16:08:33","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":942298,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-4558292/v1/78d3db96-3725-4367-83e5-5557ddcf27bd.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Analysis of clinical factors in endometriosis of the abdominal wall","fulltext":[{"header":"Introduction","content":"\u003cp\u003eEndometriosis refers to the location of the glands and mesenchyme of the endometrium outside the uterine lining, accompanied by cyclical pain during menstruation, and is one of the most common gynaecological endocrine disorders, affecting approximately 5-10% of women\u003csup\u003e\u0026nbsp;[1]\u003c/sup\u003e. The most common site of endometriosis is the pelvis, with the ovaries and the vaginal-rectal fossa being the most common sites. It is less common to find endometriosis outside the pelvis, with abdominal wall endometriosis being the most common, with a prevalence of about 0.03%-3.5% according to relevant studies \u003csup\u003e[2]\u003c/sup\u003e. Abdominal wall endometriosis (AWE) refers to the infiltration of endometrial glands and mesenchyme into the abdominal wall, mostly secondary to a history of gynaecological surgery such as caesarean section, uterine and ovarian surgery. With the recent increase in the caesarean section rate, the incidence of AWE has gradually increased, and the variability of its clinical manifestations, time of occurrence and other disease characteristics has gradually increased, making it difficult to distinguish from some diseases such as lipoma, haematoma, granuloma and other diseases. In addition, there are fewer research reports on the diagnosis and treatment of AWE both domestically and internationally. In this paper, by collecting and analysing the clinical data of abdominal wall endometriosis in our hospital from 2013 to 2022, we summarise the aetiology, clinical characteristics, treatment and prognosis of abdominal wall endometriosis, hoping to provide new ideas for the clinical diagnosis and treatment of abdominal wall endometriosis.\u003c/p\u003e"},{"header":"1. Information and methodology","content":"\u003cp\u003e\u003cstrong\u003e1.1. Source of information\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eA total of 228 patients with abdominal wall endometriosis who attended Changzhou Second People\u0026apos;s Hospital affiliated with Nanjing Medical University from January 2013 to December 2022 were collected, and all of them underwent resection for abdominal wall lesions in our hospital after excluding contraindications to surgery, and postoperative pathology suggested abdominal wall endometriosis. Complete clinical and follow-up data are available.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e1.2. Clinical information collection\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003ePatients\u0026apos; age, number of pregnancies and births, number of caesarean sections, latency period, surgical history, BMI, CA125, lactate dehydrogenase, alkaline phosphatase, imaging, operation time, bleeding and hospital stay were recorded. We divided the patients into three groups according to the depth of invasion of the lesion: fascial (invasion of subcutaneous fat or superficial fascia), rectus abdominis (lesion invasion of the anterior sheath or muscle), and peritoneal (lesion invasion of the peritoneum)\u003csup\u003e\u0026nbsp;[3]\u003c/sup\u003e. Based on whether the lesion was solitary or not, we classified patients into simple and complex types.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e1.3.Statistical methods\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eSPSS 26.0 statistical software was used, and measures conforming to normal distribution were described by X\u0026plusmn;S, and the t-test was used for two groups of data. Multi-group data were tested using the ANOVA test: measures not conforming to normal distribution were described as the median (P25-P75). The Mann-Whitney U test was used for two groups of data and the Kruskal-Wallis test for multiple groups of data. Relationships between the two variables were analysed using linear regression correlation analysis, the Person chi-square test for unordered categorical variables, and ROC curves in the predictive model. p\u0026lt;0.05 was considered a statistically significant difference.\u003c/p\u003e"},{"header":"2. Result","content":"\u003cp\u003e\u003cstrong\u003e2.1. General Patient Situation\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe mean age of onset was 32.7\u0026plusmn;4.2 years (23-51 years) in 228 patients with abdominal wall endometriosis.Of these, 226 (99.1%) had a history of previous caesarean section and 153 (67.7%) underwent a single caesarean section.The surgical scar was a transverse abdominal wall incision in 210 patients (92. The surgical scar was a transverse incision of the abdominal wall in 210 patients (92.9%) and a vertical incision of the abdominal wall in 16 (7.1%).In the remaining two cases, one patient had primary abdominal wall endometriosis, one patient had an abdominal wall incision and the other patient had primary abdominal wall endometriosis. Of the remaining two patients, one had previous surgery for leiomyoma and one had primary abdominal wall heterotaxy.Pain in the abdominal wall scar during cyclic menstruation was the first clinical manifestation in 113 patients (77.9%).A palpable abdominal wall mass was the first symptom in 40 patients (17.5%). Heterotopic foci in the original surgical scar were found at caesarean section in 7 patients (3.4%).Pale bloody discharge from the abdominal wall during menstruation was the first symptom in 1 patient.A surgical scar in the abdominal wall was the first symptom in the remaining 2 patients. effusion as the first symptom.2 cases were due to the discovery of ectopic foci in the abdominal wall during ovarian surgery (see Table 1 for details).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e2.2. Data comparison\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e2.2.1. Comparison of general information on single-type lesions and multiple-type lesions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe total number of solitary type lesions was 188 (82.5%) and the difference in BMI, operative time, intraoperative bleeding and postoperative hospital stay was statistically significant (p\u0026lt;0.05) compared to complex type patients. That is, complex patients had lower body weight, longer operation time, more bleeding and longer postoperative hospital stay. There was no statistically significant difference (p\u0026gt;0.05) in age, latency, duration of symptoms, CA125, LDH, ALP, PT, FIB and maximum lesion diameter. We found that the number of caesarean sections was lower in patients with multifocal lesions than in those with solitary lesions, and the difference was statistically significant. However, related studies concluded that the number of caesarean sections and the number of lesions did not have a significant relationship, so larger data are needed to prove this further [6]. See Table 2 for details.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cstrong\u003e2.2.2.\u0026nbsp;\u003c/strong\u003eComparison of general information on different lesion types\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eBased on the depth of infiltration of the lesions, abdominal wall endometriosis was classified into fascial, rectus abdominis and peritoneal types. There was no statistically significant difference between these three types in terms of age, BMI, number of caesarean sections, duration of symptoms, LDH, ALP, PT and FIB (p\u0026gt;0.05). Patients with the peritoneal type had a longer incubation period, a larger maximum diameter of the lesion, a higher CA125 level and a longer operative time, bleeding and postoperative hospital stay compared to the other two types. The difference was statistically significant (p\u0026lt;0.05).See Table 3 for details.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cstrong\u003e2.2.3.\u0026nbsp;\u003c/strong\u003eComparison of information on different incision types\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eApproximately 173 cases of transverse incision caesarean section were of the simple type and 37 cases were of the complex type. Among the patients with vertical incision caesarean section, there were 15 cases of simple type and 6 cases of complicated type. The difference between the two comparisons was not statistically significant (see Table 4 for details). The likelihood of the lesion being on the right side was slightly higher in the transverse incision than on the left side (see Table 5 for details).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cstrong\u003e2.2.4.\u0026nbsp;\u003c/strong\u003eLinear regression relationship between lesion diameter and clinical indicators\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe maximum diameter of the lesion was related to the duration of surgery, the amount of bleeding, the duration of postoperative hospitalisation, the incubation period, CA125 and the type of lesion (see Table 6 for details). And all of them showed a linear relationship (see Figure 1), suggesting that the deeper the infiltration depth of the lesion, the longer the incubation period, and the larger the lesion at the time of appearance of clinical symptoms.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cstrong\u003e2.2.5.\u0026nbsp;\u003c/strong\u003eImaging\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e218 patients underwent preoperative ultrasound examination of the abdominal wall, and 17 of them were also given MRI examination. By comparing the ultrasound, surgical and MRI data, we found that there was no significant difference between the three in determining the maximum diameter of the lesion and whether the lesions were multiple (p\u0026gt;0.05). In determining the depth of the lesions, nuclear magnetic resonance was more accurate than ultrasound (p\u0026lt;0.05)(see Table 7 for details).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cstrong\u003e2.2.6.\u0026nbsp;\u003c/strong\u003eAnticipate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe used ROC curve for combined ultrasound and CA125 for prediction of peritoneal versus non-peritoneal lesions. The cut-off value was 25.27 U/ml,at which point the sensitivity was 88.9%, the specificity 97.6% and the Yoden index 0.865.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cstrong\u003e2.3.\u0026nbsp;\u003c/strong\u003eDrug therapy, prognosis and relapse\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eEight patients were treated conservatively with GnRH-a medication prior to surgery, and after 3 courses of treatment, the size of the abdominal wall lesions decreased compared to the size before medication, with no significant improvement in symptoms. Symptoms worsened after stopping the medication and all were admitted to hospital for surgical treatment. All surgical patients were not treated with medication after surgery, and at postoperative follow-up (11-131 months), except for 49 patients who were lost to follow-up, 6 of 179 patients (3.4%) had a recurrence. Of these, 4 cases were treated with surgery in an outside hospital, 1 case was not treated due to minor symptoms, and 1 case was treated conservatively with medication.\u003c/p\u003e"},{"header":"3. Discussion","content":"\u003cp\u003eAbdominal wall endometriosis is one of the rarest forms of endometriosis and most cases are seen after a caesarean section or pelvic surgery with endometrial implantation in the abdominal wall. In this study, we collected 228 cases treated over the last 10 years to gather relevant clinical data to help us better understand this type of disease.\u003c/p\u003e\n\u003cp\u003eThe mechanism of endometriosis formation in the abdominal wall is not clear, and there are theories of local implantation, epithelial metaplasia, lymphatic or blood dissemination \u003csup\u003e[4]\u003c/sup\u003e. Among these, the local implantation doctrine proposed by Sampson et al. is now widely accepted in clinical practice. This doctrine suggests that when patients with AWE undergo caesarean section or other uterine surgery, the endothelial tissue is implanted into the abdominal wall wounds, causing a local focal inflammatory response with hormonal fluctuations. 99.6% of patients in this study had a history of related surgery, which is consistent with the study by Zhang et al\u003csup\u003e\u0026nbsp;[5, 6, 7]\u003c/sup\u003e and in line with this type of teaching. In patients with primary AWE, epithelial hyperplasia, lymphatic or blood dissemination would then better explain its formation.\u003c/p\u003e\n\u003cp\u003eThe typical triad of AWE: history of previous caesarean section, localised abdominal mass and cyclical pain \u003csup\u003e[8]\u003c/sup\u003e. Recent clinical studies have confirmed caesarean section as an independent risk factor for AWE\u003csup\u003e\u0026nbsp;[9]\u003c/sup\u003e. In this study, 99.1% of patients had a history of caesarean section, 178 patients (78.1%) had their first symptom of cyclical pain, and 40 patients (17.5%) had their first symptom of abdominal wall mass. Not all patients with AWE had this symptom, one patient in our collection was admitted for menstrual fluid discharge from a primary abdominal wall wound and nine were asymptomatic due to other intraoperative findings. The size of the local abdominal mass may increase with the menstrual cycle, and the local skin colour has changed to dark red in some patients\u003csup\u003e\u0026nbsp;[8]\u003c/sup\u003e. Symptoms are different when the lesion is in different locations. Depending on the depth of infiltration, they are classified as fascial, rectus abdominis and peritoneal. The first two are more common in the clinic and their clinical manifestations are more obvious. Patients with the peritoneal type often present with localised wound discomfort because the lesion is in a deeper location. In addition, this study found that the incubation period of this type was also longer than the previous two, which is also consistent with the study by Jiang et al \u003csup\u003e[10]\u003c/sup\u003e.\u003c/p\u003e\n\u003cp\u003eIn addition to the general physical examination, imaging is one of the most important modalities used clinically to diagnose AWE. Recent studies suggest that the diagnostic accuracy of abdominal ultrasound in AWE is 73.2% to 96.3% \u003csup\u003e[11]\u003c/sup\u003e. In this case, a total of 218 patients underwent preoperative abdominal ultrasound, and all were consistent with postoperative pathology. Ultrasound can clearly delineate the border between the lesion and the surrounding tissue, and blood flow visualisation can show striated or punctate blood flow in or around the lesion\u003csup\u003e\u0026nbsp;[12]\u003c/sup\u003e. It is also widely used for preoperative diagnosis because it is convenient, non-invasive and inexpensive. However, it is difficult to diagnose the extent and depth of lesion involvement using ultrasound. In this study, we compared the lesion with ultrasound and nuclear magnetic resonance (NMR) and found that NMR had better accuracy. In addition, when ultrasound cannot clearly diagnose the type of lesion, MRI is more advantageous \u003csup\u003e[13]\u003c/sup\u003e.\u003c/p\u003e\n\u003cp\u003eLaboratory tests consist mainly of tumour indicators such as CA125 levels. It is currently not considered clinically specific for the diagnosis of abdominal wall endometriosis. In this study, CA125 was compared according to the depth of infiltration of the lesion, and the three were found to be statistically significant. The CA125 levels in patients with the peritoneal type were significantly higher than the other two types. We analysed that this might be related to the longer incubation period of the peritoneal type and the large diameter of the lesion and the extent of infiltration, which is consistent with the study by Li et al.\u003csup\u003e[7]\u003c/sup\u003e However, in this study, we compared the simple lesion and the complex type lesion and found that there was no significant difference between the two. Therefore, we believe that CA125 is necessary for preoperative examination and can be used as one of the reference indices for clinical lesion typing. However, its accuracy still needs to be proven by a large amount of data and research.\u003c/p\u003e\n\u003cp\u003eThe main treatments for AWE are medication, surgery and high-intensity focused ultrasound \u003csup\u003e[3]\u003c/sup\u003e.Pharmacological treatment includes progestins, short-acting contraceptives and gonadotropin-releasing hormone analogues. Pharmacological treatment is usually ineffective because the lesion is encapsulated by connective tissue. Long-term treatment with this type of hormonal medication has adverse effects on the body, and symptoms usually worsen when the medication is stopped. In this trial, eight patients were treated conservatively with GnRH-a, but the results were poor. Therefore, in clinical practice, conservative treatment with medication is usually reserved for patients with contraindications to surgery. Surgery is the most important way to prevent recurrence of AWE, and whether or not the lesion can be completely removed during surgery largely determines whether or not AWE will recur. Surgery is usually performed through an incision in the original abdominal wall, and an ultrasonic knife is used to make a complete resection along the edge of the lesion of 0.5-1 cm, and the existing scar on the abdominal wall should also be removed. For large infiltrating lesions, such as rectus abdominis or peritoneal lesions, placement of a drain after surgery may be considered to aid wound healing. For large, high-tensile lesions that are difficult to suture, we generally use intraoperative patch placement to cover the defect, reduce local tension and beautify the wound. In this study, four patients with peritoneal lesions \u0026gt;5 cm in diameter received intraoperative patches and postoperative negative pressure drainage, and the wounds healed well\u003csup\u003e\u0026nbsp;[14]\u003c/sup\u003e. The maximum diameter of intraoperative peritoneal lesions was found to be significantly larger than the other two types. We believe that this may be due to its deeper location, longer latency period and richer peritoneal blood supply. In addition, operative time, intraoperative bleeding and postoperative hospital stay were statistically significant for this type. Therefore, patients with peritoneal abdominal wall endometriosis should be better prepared for surgery and the lesions should be more carefully isolated and removed during surgery. Regarding the use of postoperative medication as a preventive measure, studies have shown that this treatment does not reduce the recurrence rate \u003csup\u003e[15, 16, 17]\u003c/sup\u003e. In this paper, 228 patients were not treated with postoperative prophylaxis and the recurrence rate after surgery was only 3.4%. High-intensity focused ultrasound is a new clinical tool currently used to treat AWE, in which low-intensity ultrasound waves from outside the body are focused on the lesion area of the abdominal wall to produce local coagulation-like necrosis. This treatment option has now been shown to be superior to traditional surgical methods in terms of operating time and bleeding. However, it can cause some damage to the surrounding tissues and has narrow indications, and the current clinical trial is relatively small, which requires further research \u003csup\u003e[18]\u003c/sup\u003e.\u003c/p\u003e\n\u003cp\u003eTo prevent AWE, the clinic should first control the rate of caesarean section and the indication for surgery. Use of isolation measures during surgery, such as placing sterile gauze or incision protectors over the wound. Repeated irrigation of the pelvis and wound after suturing the uterus to avoid local endothelial implantation. Avoid using the same suture when suturing the uterine incision and other tissues etc \u003csup\u003e[19,20]\u003c/sup\u003e.AWE is most common in fascial and rectus abdominis types and occurs on both sides of the wound. It may be related to the limitations of the operation, resulting in the ease of implantation of endothelial tissue compared to other sites. Therefore, repeated irrigation prior to closure of the abdomen to release only the fascial layer appears to be important. It has been suggested that by comparing cesarean transverse incision with straight incision, it was found that the latency period of straight incision is longer than transverse incision and it was suggested that straight incision in cesarean section is better than transverse incision for prevention of AWE \u003csup\u003e[5]\u003c/sup\u003e. In the present study, the latency period was compared between the two, 3.6\u0026plusmn;2.02 years for straight incision and 3.5\u0026plusmn;2.33 years for transverse incision and found to be statistically insignificant (p\u0026gt;0.05). It was therefore concluded that the two approaches did not increase the likelihood of AWE. However, a large amount of data is still needed for further studies.\u003c/p\u003e\n\u003cp\u003eIn conclusion, with the increase of caesarean section rate in recent years, the incidence of AWE has also gradually increased, so we do a good job in intraoperative tumour-free defence measures. In the face of clinical history of uterine surgery, abdominal wall mass and cyclical pain patients should be highly suspected of AWE, in perfect ultrasound and CA125 and other auxiliary examination, early surgical treatment to avoid further increase in the diameter of the lesion. For patients with complex lesions, relevant imaging should be perfected preoperatively, and intraoperative exploration should be carefully carried out to resect possible lesions to avoid postoperative remnants leading to recurrence and secondary surgery. In patients with abdominal wall endometriosis, postoperative medical treatment has no effect on recurrence. Therefore, preoperative and postoperative medication should be fully considered. The study sample in this paper is relatively small and the conclusions need to be confirmed by a large amount of data.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eDeclaration of interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.\u003c/p\u003e\n\u003cp skip=\"true\"\u003e\u003cstrong\u003eFunding details\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eChangzhou Municipal Health Commission Science and Technology Project (ZD202314); Changzhou \u0026quot;14th Five-Year Plan\u0026quot; High-level Talent Cultivation Project (2022CZBJ074); Jiangsu Province Maternal and Child Health Key Talent Project (RC202101); Jiangsu Province Maternal and Child Health Scientific Research Project (F202138). Postdoctoral Research Support Programme of Jiangsu Province (2019K064); Jiangsu Province \u0026quot;333 Project\u0026quot; Research Support Programme (BRA2019161).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe data supporting the conclusions of this article is available from corresponding author.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eInformed Consent Statement\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eInformed consent was obtained from all subjects involved in the study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTrial registration\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe study was conducted in accordance with the Declaration of Helsinki.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics declaration\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis was a retrospective tiger study and ethical approval was obtained from the Ethics Committee of Changzhou Second People\u0026apos;s Hospital affiliated with Nanjing Medical University.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eTaylor HS, Kotlyar AM, Flores VA. Endometriosis is a chronic systemic disease: clinical challenges and novel innovations. Lancet. 2021;397(10276):839-852. doi:10.1016/S0140-6736(21)00389-5\u003c/li\u003e\n\u003cli\u003eCarsote M, Terzea DC, Valea A, Gheorghisan-Galateanu AA. Abdominal wall endometriosis (a narrative review). Int J Med Sci. 2020;17(4):536-542. Published 2020 Feb 10. doi:10.7150/ijms.38679\u003c/li\u003e\n\u003cli\u003eQiu Lingbing,Li Jinbo,Chen Shuqin. Research progress of endometriosis in the abdominal wall[J]. International Journal of Obstetrics and Gynaecology,2023,50(05):545-549.\u003c/li\u003e\n\u003cli\u003eHorton JD, Dezee KJ, Ahnfeldt EP, Wagner M. Abdominal wall endometriosis: a surgeon\u0026apos;s perspective and review of 445 cases. Am J Surg. 2008;196(2):207-212. doi:10.1016/j.amjsurg.2007.07.035\u003c/li\u003e\n\u003cli\u003eZhang P, Sun Y, Zhang C, et al. Cesarean scar endometriosis: presentation of 198 cases and literature review. BMC Womens Health. 2019;19(1):14. Published 2019 Jan 18. doi:10.1186/s12905-019-0711-8\u003c/li\u003e\n\u003cli\u003eChen Yahui,Wang Yannan,Wang Lin et al.Analysis of clinical factors associated with 501 cases of abdominal wall endometriosis[J]. Progress in Modern Obstetrics and Gynaecology,2023,32(10):768-771+775.DOI:10.13283/j.cnki.xdfckjz.2023.10.032.\u003c/li\u003e\n\u003cli\u003eLi R,Shi Shaole,Zhang Hui et al.Clinical analysis of 241 cases of endometriosis in the abdominal wall[J]. Progress in Modern Obstetrics and Gynaecology,2021,30(07):508-513+519.DOI:10.13283/j.cnki.xdfckjz.2021.07.038.\u003c/li\u003e\n\u003cli\u003eZHANG Wen,Leng Jinhua. Research progress in the diagnosis and treatment of endometriosis in the abdominal wall[J]. Progress in Modern Obstetrics and Gynaecology,2019,28(05):391-392.DOI:10.13283/j.cnki.xdfckjz.2019.05.017\u003c/li\u003e\n\u003cli\u003eFoley CE, Ayers PG, Lee TT. Abdominal Wall Endometriosis. Obstet Gynecol Clin North Am. 2022;49(2):369-380. doi:10.1016/j.ogc.2022.02.013\u003c/li\u003e\n\u003cli\u003eJIANG Mengyu,LI Liuxia,ZHU Ying. Analysis of clinical characteristics and prognosis of 231 cases of abdominal wall endometriosis[J]. Chinese Journal of Practical Gynaecology and Obstetrics,2020,36(04):361-364.DOI:10.19538/j.fk2020040116.\u003c/li\u003e\n\u003cli\u003eGong Xiaorong. Colour Doppler ultrasound performance and diagnostic value of endometriosis in the abdominal wall[J]. Chinese Journal of Clinical Medical Imaging,2011,22(05):365-366.\u003c/li\u003e\n\u003cli\u003eXu Yang. Analysis of the diagnostic value of colour ultrasound on endometriosis in the abdominal wall[J]. China Modern Drug Application,2022,16(08):67-69.DOI:10.14164/j.cnki.cn11-5581/r.2022.08.024.\u003c/li\u003e\n\u003cli\u003eChami\u0026eacute; LP, Ribeiro DMFR, Tiferes DA, Macedo Neto AC, Serafini PC. Atypical Sites of Deeply Infiltrative Endometriosis: Clinical Characteristics and Imaging Findings. Radiographics. 2018;38(1):309-328. doi:10.1148/rg.2018170093\u003c/li\u003e\n\u003cli\u003eDeng Shan,Leng Jinhua,Lang Jinghe et al. Feasibility analysis of preoperative predictive patching for abdominal wall endometriosis[J]. International Journal of Obstetrics and Gynaecology,2013,40(04):364-368.\u003c/li\u003e\n\u003cli\u003eGuo Ailian,Ma Dehua,Lu Caixia et al.Pathogenesis characteristics and clinical diagnosis and treatment of 197 patients with endometriosis in the abdominal wall[J]. Shandong Medicine,2021,61(04):69-71\u003c/li\u003e\n\u003cli\u003eJiang Mengyu. Diagnosis, treatment and prognosis analysis of endometriosis in the abdominal wall[D]. Zhengzhou University,2021.DOI:10.27466/d.cnki.gzzdu.2020.004473.\u003c/li\u003e\n\u003cli\u003eZhang Lu,Zhao Junda,Zhang Shaofen et al.Clinical analysis of 496 cases of endometriosis in the abdominal wall[J]. Progress in Modern Obstetrics and Gynaecology,2017,26(08):599-602.DOI:10.13283/j.cnki.xdfckjz.2017.08.009.\u003c/li\u003e\n\u003cli\u003eWang Sha,Duan Hua. Comparative study on the efficacy of high-intensity focused ultrasound ablation and surgical excision for the treatment of endometriosis in the abdominal wall[J]. International Journal of Obstetrics and Gynaecology,2023,50(03):261-265.\u003c/li\u003e\n\u003cli\u003eWEI Qiang,LIU Xinghui. Tumour-free defence issues in caesarean section - prevention of endometriosis in the abdominal wall[J]. Chinese Journal of Practical Gynaecology and Obstetrics,2023,39(01):31-34.DOI:10.19538/j.fk2023010110.\u003c/li\u003e\n\u003cli\u003ePoismans G, Tolbize N, Gielen F, Lipombi D. PR\u0026Eacute;VENTION DE L\u0026apos;ENDOM\u0026Eacute;TRIOSE PARI\u0026Eacute;TALE POST-C\u0026Eacute;SARIENNE [POST-CAESAREAN ABDOMINAL WALL ENDOMETRIOSIS PREVENTION]. Rev Med Liege. 2016;71(4):193-197.\u003c/li\u003e\n\u003c/ol\u003e"},{"header":"Tables","content":"\u003cp\u003eTable 1 \u0026nbsp;General information on the condition of patients with internal heterotaxy of the abdominal wall\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"48.41549295774648%\" valign=\"top\"\u003e\n \u003cp\u003eFeatures\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.309859154929576%\" valign=\"top\"\u003e\n \u003cp\u003en（%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"33.274647887323944%\" valign=\"top\"\u003e\n \u003cp\u003eX\u0026plusmn;S (range)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"48.41549295774648%\" valign=\"top\"\u003e\n \u003cp\u003eAge (years)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.309859154929576%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"33.274647887323944%\" valign=\"top\"\u003e\n \u003cp\u003e32.7\u0026plusmn;4.2（23-51）\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"48.41549295774648%\" valign=\"top\"\u003e\n \u003cp\u003eBMI（kg/m\u0026sup2;）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.309859154929576%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"33.274647887323944%\" valign=\"top\"\u003e\n \u003cp\u003e22.75\u0026plusmn;3.65（16.9-38.2）\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"48.41549295774648%\" valign=\"top\"\u003e\n \u003cp\u003eCA125\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.309859154929576%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"33.274647887323944%\" valign=\"top\"\u003e\n \u003cp\u003e27.28\u0026plusmn;20.45\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"48.41549295774648%\" valign=\"top\"\u003e\n \u003cp\u003eLDH\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.309859154929576%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"33.274647887323944%\" valign=\"top\"\u003e\n \u003cp\u003e154.74\u0026plusmn;23.14\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"48.41549295774648%\" valign=\"top\"\u003e\n \u003cp\u003eALP\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.309859154929576%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"33.274647887323944%\" valign=\"top\"\u003e\n \u003cp\u003e60.79\u0026plusmn;18.18\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"48.41549295774648%\" valign=\"top\"\u003e\n \u003cp\u003eFIB\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.309859154929576%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"33.274647887323944%\" valign=\"top\"\u003e\n \u003cp\u003e2.82\u0026plusmn;1.67\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"48.41549295774648%\" valign=\"top\"\u003e\n \u003cp\u003ePT\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.309859154929576%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"33.274647887323944%\" valign=\"top\"\u003e\n \u003cp\u003e11.37\u0026plusmn;0.62\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"48.41549295774648%\" valign=\"top\"\u003e\n \u003cp\u003eNumber of caesarean sections\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.309859154929576%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"33.274647887323944%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"48.41549295774648%\" valign=\"top\"\u003e\n \u003cp\u003e1 (case)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.309859154929576%\" valign=\"top\"\u003e\n \u003cp\u003e153（67.7%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"33.274647887323944%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"48.41549295774648%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026ge;2 (cases)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.309859154929576%\" valign=\"top\"\u003e\n \u003cp\u003e73（32.3%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"33.274647887323944%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"48.41549295774648%\" valign=\"top\"\u003e\n \u003cp\u003eCesarean section incision\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.309859154929576%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"33.274647887323944%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"48.41549295774648%\" valign=\"top\"\u003e\n \u003cp\u003eTransverse incision\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.309859154929576%\" valign=\"top\"\u003e\n \u003cp\u003e210（92.9%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"33.274647887323944%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"48.41549295774648%\" valign=\"top\"\u003e\n \u003cp\u003eVertical incision\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.309859154929576%\" valign=\"top\"\u003e\n \u003cp\u003e16（7.1%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"33.274647887323944%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"48.41549295774648%\" valign=\"top\"\u003e\n \u003cp\u003eIncubation period (years)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.309859154929576%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"33.274647887323944%\" valign=\"top\"\u003e\n \u003cp\u003e3.59\u0026plusmn;2.04（1-9）\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"48.41549295774648%\" valign=\"top\"\u003e\n \u003cp\u003eSymptoms to surgery (years)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.309859154929576%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"33.274647887323944%\" valign=\"top\"\u003e\n \u003cp\u003e0.96\u0026plusmn;0.65\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"48.41549295774648%\" valign=\"top\"\u003e\n \u003cp\u003eClinical manifestation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.309859154929576%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"33.274647887323944%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"48.41549295774648%\" valign=\"top\"\u003e\n \u003cp\u003eCycle pain (cases)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.309859154929576%\" valign=\"top\"\u003e\n \u003cp\u003e178（78.1%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"33.274647887323944%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"48.41549295774648%\" valign=\"top\"\u003e\n \u003cp\u003eAbdominal masses (cases)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.309859154929576%\" valign=\"top\"\u003e\n \u003cp\u003e40（17.5%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"33.274647887323944%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"48.41549295774648%\" valign=\"top\"\u003e\n \u003cp\u003eOther symptoms (cases)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.309859154929576%\" valign=\"top\"\u003e\n \u003cp\u003e10（4.4%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"33.274647887323944%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"48.41549295774648%\" valign=\"top\"\u003e\n \u003cp\u003eLesion depth\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.309859154929576%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"33.274647887323944%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"48.41549295774648%\" valign=\"top\"\u003e\n \u003cp\u003eFascia type (cases)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.309859154929576%\" valign=\"top\"\u003e\n \u003cp\u003e99（43.4%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"33.274647887323944%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"48.41549295774648%\" valign=\"top\"\u003e\n \u003cp\u003eRectus abdominis (case)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.309859154929576%\" valign=\"top\"\u003e\n \u003cp\u003e108（47.4%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"33.274647887323944%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"48.41549295774648%\" valign=\"top\"\u003e\n \u003cp\u003ePeritoneal type (cases)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.309859154929576%\" valign=\"top\"\u003e\n \u003cp\u003e21（9.2%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"33.274647887323944%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"48.41549295774648%\" valign=\"top\"\u003e\n \u003cp\u003eFocus of infection\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.309859154929576%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"33.274647887323944%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"48.41549295774648%\" valign=\"top\"\u003e\n \u003cp\u003eSingle hair type (case)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.309859154929576%\" valign=\"top\"\u003e\n \u003cp\u003e188（82.5%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"33.274647887323944%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"48.41549295774648%\" valign=\"top\"\u003e\n \u003cp\u003eComplex type (cases)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.309859154929576%\" valign=\"top\"\u003e\n \u003cp\u003e40（17.5%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"33.274647887323944%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"48.41549295774648%\" valign=\"top\"\u003e\n \u003cp\u003eImaging\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.309859154929576%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"33.274647887323944%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"48.41549295774648%\" valign=\"top\"\u003e\n \u003cp\u003eUltrasound (cases)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.309859154929576%\" valign=\"top\"\u003e\n \u003cp\u003e218（95.6%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"33.274647887323944%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"48.41549295774648%\" valign=\"top\"\u003e\n \u003cp\u003eMRI (cases)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.309859154929576%\" valign=\"top\"\u003e\n \u003cp\u003e17（7.5%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"33.274647887323944%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"48.41549295774648%\" valign=\"top\"\u003e\n \u003cp\u003eCuring\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.309859154929576%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"33.274647887323944%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"48.41549295774648%\" valign=\"top\"\u003e\n \u003cp\u003ePreoperative drug treatment (cases)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.309859154929576%\" valign=\"top\"\u003e\n \u003cp\u003e8（3.5%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"33.274647887323944%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"48.41549295774648%\" valign=\"top\"\u003e\n \u003cp\u003eSurgical treatment (cases)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.309859154929576%\" valign=\"top\"\u003e\n \u003cp\u003e228（100%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"33.274647887323944%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"48.41549295774648%\" valign=\"top\"\u003e\n \u003cp\u003eIntraoperative mesh (cases)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.309859154929576%\" valign=\"top\"\u003e\n \u003cp\u003e4（1.8%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"33.274647887323944%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"48.41549295774648%\" valign=\"top\"\u003e\n \u003cp\u003ePostoperative medication (cases)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.309859154929576%\" valign=\"top\"\u003e\n \u003cp\u003e0%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"33.274647887323944%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n\u003cp\u003eTable 2 \u0026nbsp;Comparison of patient data for solitary versus complicated abdominal wall endometriosis (using Mann-Whitney U test; one-way ANOVA)\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"605\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"26.821192052980134%\"\u003e\n \u003cp\u003eLesion type\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.99337748344371%\"\u003e\n \u003cp\u003eSingle-incidence type\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;(188 cases)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.026490066225165%\"\u003e\n \u003cp\u003eComplex\u003c/p\u003e\n \u003cp\u003e(40 cases)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.2317880794702%\"\u003e\n \u003cp\u003eStatistic\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.927152317880795%\"\u003e\n \u003cp\u003eP\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"26.821192052980134%\"\u003e\n \u003cp\u003eAge (years)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.99337748344371%\"\u003e\n \u003cp\u003e32.81\u0026plusmn;4.31\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.026490066225165%\"\u003e\n \u003cp\u003e32.30\u0026plusmn;3.79\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.2317880794702%\"\u003e\n \u003cp\u003eF=0.239\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.927152317880795%\"\u003e\n \u003cp\u003e0.626\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"26.821192052980134%\"\u003e\n \u003cp\u003eBMI\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.99337748344371%\"\u003e\n \u003cp\u003e22.58\u003c/p\u003e\n \u003cp\u003e（20.8-24.98）\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.026490066225165%\"\u003e\n \u003cp\u003e20.99（19.63-22.41）\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.2317880794702%\"\u003e\n \u003cp\u003eZ=-2.543\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.927152317880795%\"\u003e\n \u003cp\u003e0.011\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"26.821192052980134%\"\u003e\n \u003cp\u003eNumber of caesarean sections\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.99337748344371%\"\u003e\n \u003cp\u003e1.37\u0026plusmn;0.508\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.026490066225165%\"\u003e\n \u003cp\u003e1.11\u0026plusmn;0.315\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.2317880794702%\"\u003e\n \u003cp\u003eZ=-2.184\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.927152317880795%\"\u003e\n \u003cp\u003e0.029\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"26.821192052980134%\"\u003e\n \u003cp\u003eIncubation period (years)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.99337748344371%\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003cp\u003e（2-5）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.026490066225165%\"\u003e\n \u003cp\u003e4（2-5）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.2317880794702%\"\u003e\n \u003cp\u003eZ=-0.683\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.927152317880795%\"\u003e\n \u003cp\u003e0.495\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"26.821192052980134%\"\u003e\n \u003cp\u003ePersistence of symptoms (years)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.99337748344371%\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003cp\u003e（0-1）\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.026490066225165%\"\u003e\n \u003cp\u003e1（0-2）\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.2317880794702%\"\u003e\n \u003cp\u003eZ=-1.463\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.927152317880795%\"\u003e\n \u003cp\u003e0.143\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"26.821192052980134%\"\u003e\n \u003cp\u003eCA125\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.99337748344371%\"\u003e\n \u003cp\u003e20.75\u003c/p\u003e\n \u003cp\u003e(13.83-31.64)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.026490066225165%\"\u003e\n \u003cp\u003e25.57\u003c/p\u003e\n \u003cp\u003e(19.34-40.59)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.2317880794702%\"\u003e\n \u003cp\u003eZ=-1.704\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.927152317880795%\"\u003e\n \u003cp\u003e0.088\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"26.821192052980134%\"\u003e\n \u003cp\u003eLDH\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.99337748344371%\"\u003e\n \u003cp\u003e152\u003c/p\u003e\n \u003cp\u003e（139-168）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.026490066225165%\"\u003e\n \u003cp\u003e147.45（139.85-162.5）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.2317880794702%\"\u003e\n \u003cp\u003eZ=-0.683\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.927152317880795%\"\u003e\n \u003cp\u003e0.567\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"26.821192052980134%\"\u003e\n \u003cp\u003eALP\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.99337748344371%\"\u003e\n \u003cp\u003e57.7\u003c/p\u003e\n \u003cp\u003e（50-69）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.026490066225165%\"\u003e\n \u003cp\u003e55.2\u003c/p\u003e\n \u003cp\u003e（47.95-67.9）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.2317880794702%\"\u003e\n \u003cp\u003eZ=-0.349\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.927152317880795%\"\u003e\n \u003cp\u003e0.727\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"26.821192052980134%\"\u003e\n \u003cp\u003ePT\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.99337748344371%\"\u003e\n \u003cp\u003e11.3\u003c/p\u003e\n \u003cp\u003e（10.9-11.7）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.026490066225165%\"\u003e\n \u003cp\u003e2.66\u003c/p\u003e\n \u003cp\u003e（2.31-3.02）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.2317880794702%\"\u003e\n \u003cp\u003eZ=-1.218\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.927152317880795%\"\u003e\n \u003cp\u003e0.223\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"26.821192052980134%\"\u003e\n \u003cp\u003eFIB\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.99337748344371%\"\u003e\n \u003cp\u003e2.52\u003c/p\u003e\n \u003cp\u003e（2.31-2.96）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.026490066225165%\"\u003e\n \u003cp\u003e2.66\u003c/p\u003e\n \u003cp\u003e（2.31-3.02）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.2317880794702%\"\u003e\n \u003cp\u003eZ=-0.936\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.927152317880795%\"\u003e\n \u003cp\u003e0.350\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"26.821192052980134%\"\u003e\n \u003cp\u003eMaximum diameter of lesion (cm)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.99337748344371%\"\u003e\n \u003cp\u003e2.5\u003c/p\u003e\n \u003cp\u003e（2-3）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.026490066225165%\"\u003e\n \u003cp\u003e2.9\u003c/p\u003e\n \u003cp\u003e（2.0-4.0）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.2317880794702%\"\u003e\n \u003cp\u003eZ=-1.778\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.927152317880795%\"\u003e\n \u003cp\u003e0.075\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"26.821192052980134%\"\u003e\n \u003cp\u003eSurgical time (min)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.99337748344371%\"\u003e\n \u003cp\u003e30\u003c/p\u003e\n \u003cp\u003e（20-45）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.026490066225165%\"\u003e\n \u003cp\u003e52.5\u003c/p\u003e\n \u003cp\u003e（31.25-75）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.2317880794702%\"\u003e\n \u003cp\u003eZ=-3.545\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.927152317880795%\"\u003e\n \u003cp\u003e\u0026lt;0.01\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"26.821192052980134%\"\u003e\n \u003cp\u003eBleeding volume (ml)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.99337748344371%\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003cp\u003e（5-10）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.026490066225165%\"\u003e\n \u003cp\u003e10\u003c/p\u003e\n \u003cp\u003e（5-10）\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.2317880794702%\"\u003e\n \u003cp\u003eZ=-2.558\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.927152317880795%\"\u003e\n \u003cp\u003e0.011\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"26.821192052980134%\"\u003e\n \u003cp\u003ePost-operative hospitalisation (days)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.99337748344371%\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003cp\u003e（3-4）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.026490066225165%\"\u003e\n \u003cp\u003e4.5\u003c/p\u003e\n \u003cp\u003e（4-5）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.2317880794702%\"\u003e\n \u003cp\u003eZ=-4.109\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.927152317880795%\"\u003e\n \u003cp\u003e\u0026lt;0.01\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n\u003cp\u003eTable 3 \u0026nbsp;Comparison of general data of patients with different lesion types (Kruskal-Wallis test; one-way ANOVA)\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"19.190140845070424%\"\u003e\n \u003cp\u003eLesion type\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.661971830985916%\"\u003e\n \u003cp\u003eFascial type\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.838028169014084%\"\u003e\n \u003cp\u003eRectus abdominis type\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.302816901408452%\"\u003e\n \u003cp\u003ePeritoneal\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.32394366197183%\"\u003e\n \u003cp\u003eStatistic\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.683098591549296%\"\u003e\n \u003cp\u003eP\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"19.190140845070424%\"\u003e\n \u003cp\u003eAge\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;(years)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.661971830985916%\"\u003e\n \u003cp\u003e32.41\u0026plusmn;3.86\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.838028169014084%\"\u003e\n \u003cp\u003e32.80\u0026plusmn;4.82\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.302816901408452%\"\u003e\n \u003cp\u003e33.73\u0026plusmn;2.05\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.32394366197183%\"\u003e\n \u003cp\u003eF=0.454\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.683098591549296%\"\u003e\n \u003cp\u003e0.636\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"19.190140845070424%\"\u003e\n \u003cp\u003eBMI\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.661971830985916%\"\u003e\n \u003cp\u003e22.21\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.838028169014084%\"\u003e\n \u003cp\u003e21.91\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.302816901408452%\"\u003e\n \u003cp\u003e21.83\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.32394366197183%\"\u003e\n \u003cp\u003e\u0026chi;2 =0.362\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.683098591549296%\"\u003e\n \u003cp\u003e0.834\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"19.190140845070424%\"\u003e\n \u003cp\u003eNumber of caesarean sections\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.661971830985916%\"\u003e\n \u003cp\u003e1.39\u0026plusmn;0.492\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.838028169014084%\"\u003e\n \u003cp\u003e1.28\u0026plusmn;0.455\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.302816901408452%\"\u003e\n \u003cp\u003e1.27\u0026plusmn;0.647\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.32394366197183%\"\u003e\n \u003cp\u003e\u0026chi;2 =1.911\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.683098591549296%\"\u003e\n \u003cp\u003e0.385\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"19.190140845070424%\"\u003e\n \u003cp\u003eIncubation period (years)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.661971830985916%\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003cp\u003e（2-4.5）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.838028169014084%\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003cp\u003e（2-5）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.302816901408452%\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003cp\u003e（4-6）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.32394366197183%\"\u003e\n \u003cp\u003e\u0026chi;2 =4.757\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.683098591549296%\"\u003e\n \u003cp\u003e0.045\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"19.190140845070424%\"\u003e\n \u003cp\u003ePersistence of symptoms (years)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.661971830985916%\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003cp\u003e（0-1）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.838028169014084%\"\u003e\n \u003cp\u003e0.5\u003c/p\u003e\n \u003cp\u003e（0-1）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.302816901408452%\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003cp\u003e（1-2）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.32394366197183%\"\u003e\n \u003cp\u003e\u0026chi;2 =6.196\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.683098591549296%\"\u003e\n \u003cp\u003e0.093\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"19.190140845070424%\"\u003e\n \u003cp\u003eCA125\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.661971830985916%\"\u003e\n \u003cp\u003e14.75（11.31-25.86）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.838028169014084%\"\u003e\n \u003cp\u003e25.57（18.85-37.7）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.302816901408452%\"\u003e\n \u003cp\u003e35.96（19.87-62.60）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.32394366197183%\"\u003e\n \u003cp\u003e\u0026chi;2 =21.209\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.683098591549296%\"\u003e\n \u003cp\u003e0.000\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"19.190140845070424%\"\u003e\n \u003cp\u003eLDH\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.661971830985916%\"\u003e\n \u003cp\u003e153（142-167.75）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.838028169014084%\"\u003e\n \u003cp\u003e149（138.2-168）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.302816901408452%\"\u003e\n \u003cp\u003e144.15（137.1-168.2）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.32394366197183%\"\u003e\n \u003cp\u003e\u0026chi;2 =1.647\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.683098591549296%\"\u003e\n \u003cp\u003e0.439\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"19.190140845070424%\"\u003e\n \u003cp\u003eALP\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.661971830985916%\"\u003e\n \u003cp\u003e57.85（53.08-70.08）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.838028169014084%\"\u003e\n \u003cp\u003e55\u003c/p\u003e\n \u003cp\u003e（45.9-68）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.302816901408452%\"\u003e\n \u003cp\u003e55.2（44.73-62.9）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.32394366197183%\"\u003e\n \u003cp\u003e\u0026chi;2 =1.677\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.683098591549296%\"\u003e\n \u003cp\u003e0.432\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"19.190140845070424%\"\u003e\n \u003cp\u003ePT\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.661971830985916%\"\u003e\n \u003cp\u003e11.3\u003c/p\u003e\n \u003cp\u003e（10.9-11.7）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.838028169014084%\"\u003e\n \u003cp\u003e11.4（11.1-11.7）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.302816901408452%\"\u003e\n \u003cp\u003e11.45（10.93-11.55）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.32394366197183%\"\u003e\n \u003cp\u003e\u0026chi;2 =0.227\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.683098591549296%\"\u003e\n \u003cp\u003e0.893\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"19.190140845070424%\"\u003e\n \u003cp\u003eFIB\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.661971830985916%\"\u003e\n \u003cp\u003e2.52\u003c/p\u003e\n \u003cp\u003e（2.27-3.02）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.838028169014084%\"\u003e\n \u003cp\u003e2.29（2.34-2.95）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.302816901408452%\"\u003e\n \u003cp\u003e2.57\u003c/p\u003e\n \u003cp\u003e（2.3-3.05）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.32394366197183%\"\u003e\n \u003cp\u003e\u0026chi;2 =0.025\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.683098591549296%\"\u003e\n \u003cp\u003e0.987\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"19.190140845070424%\"\u003e\n \u003cp\u003eMaximum diameter of lesion (cm)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.661971830985916%\"\u003e\n \u003cp\u003e2.0\u003c/p\u003e\n \u003cp\u003e（1.65-3.0）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.838028169014084%\"\u003e\n \u003cp\u003e2.5（2.0-3.125）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.302816901408452%\"\u003e\n \u003cp\u003e3.0\u003c/p\u003e\n \u003cp\u003e（2.5-4.0）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.32394366197183%\"\u003e\n \u003cp\u003e\u0026chi;2 =10.395\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.683098591549296%\"\u003e\n \u003cp\u003e0.006\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"19.190140845070424%\"\u003e\n \u003cp\u003eSurgical time (min)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.661971830985916%\"\u003e\n \u003cp\u003e30\u003c/p\u003e\n \u003cp\u003e（17.5-45）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.838028169014084%\"\u003e\n \u003cp\u003e35\u003c/p\u003e\n \u003cp\u003e（25-50）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.302816901408452%\"\u003e\n \u003cp\u003e55\u003c/p\u003e\n \u003cp\u003e（30-75）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.32394366197183%\"\u003e\n \u003cp\u003e\u0026chi;2 =9.522\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.683098591549296%\"\u003e\n \u003cp\u003e0.009\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"19.190140845070424%\"\u003e\n \u003cp\u003eBleeding volume (ml)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.661971830985916%\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003cp\u003e（5-10）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.838028169014084%\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003cp\u003e（5-10）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.302816901408452%\"\u003e\n \u003cp\u003e10\u003c/p\u003e\n \u003cp\u003e（5-10）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.32394366197183%\"\u003e\n \u003cp\u003e\u0026chi;2 =6.824\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.683098591549296%\"\u003e\n \u003cp\u003e0.033\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"19.190140845070424%\"\u003e\n \u003cp\u003ePost-operative hospitalisation (days)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.661971830985916%\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003cp\u003e（3-3）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.838028169014084%\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003cp\u003e（4-4）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.302816901408452%\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003cp\u003e（5-6）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.32394366197183%\"\u003e\n \u003cp\u003e\u0026chi;2 =56.649\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.683098591549296%\"\u003e\n \u003cp\u003e\u0026lt;0.01\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;Table 4 \u0026nbsp;Effect of cesarean section incision orientation on lesion type (Person\u0026apos;s chi-square test)\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"18.01801801801802%\"\u003e\n \u003cp\u003eDirection of incision\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.396396396396398%\"\u003e\n \u003cp\u003eNumber of \u0026nbsp; \u0026nbsp;examples \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.36036036036036%\"\u003e\n \u003cp\u003eFloppy\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.117117117117118%\"\u003e\n \u003cp\u003eComplex type\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.675675675675675%\"\u003e\n \u003cp\u003eChi-square value\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.432432432432432%\"\u003e\n \u003cp\u003eP\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"18.01801801801802%\"\u003e\n \u003cp\u003eTransverse incision\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.396396396396398%\"\u003e\n \u003cp\u003e210\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.36036036036036%\"\u003e\n \u003cp\u003e173（82.4%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.117117117117118%\"\u003e\n \u003cp\u003e37（17.6%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.675675675675675%\" rowspan=\"2\"\u003e\n \u003cp\u003e1.374\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.432432432432432%\" rowspan=\"2\"\u003e\n \u003cp\u003e0.241\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"25.06265664160401%\"\u003e\n \u003cp\u003eVertical incision\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.80701754385965%\"\u003e\n \u003cp\u003e16\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"28.32080200501253%\"\u003e\n \u003cp\u003e15\u003c/p\u003e\n \u003cp\u003e（93.8%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.80952380952381%\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003cp\u003e（6.2%）\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n\u003cp\u003eTable 5 \u0026nbsp;Location of lesions at different incisions\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"567\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"30.809859154929576%\" valign=\"top\"\u003e\n \u003cp\u003eDirection of incision\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"30.809859154929576%\" valign=\"top\"\u003e\n \u003cp\u003eLesion location\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"38.38028169014085%\" valign=\"top\"\u003e\n \u003cp\u003eCounting\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"30.809859154929576%\" rowspan=\"4\"\u003e\n \u003cp\u003eTransverse incision\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"30.809859154929576%\" valign=\"top\"\u003e\n \u003cp\u003etotal\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"38.38028169014085%\" valign=\"top\"\u003e\n \u003cp\u003e210（100%）\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"44.529262086513995%\" valign=\"top\"\u003e\n \u003cp\u003eleft side\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"55.470737913486005%\" valign=\"top\"\u003e\n \u003cp\u003e92（43.8%）\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"44.529262086513995%\" valign=\"top\"\u003e\n \u003cp\u003einterlocutory\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"55.470737913486005%\" valign=\"top\"\u003e\n \u003cp\u003e4（1.9%）\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"44.529262086513995%\" valign=\"top\"\u003e\n \u003cp\u003eright side\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"55.470737913486005%\" valign=\"top\"\u003e\n \u003cp\u003e114（54.3%）\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"30.809859154929576%\" rowspan=\"4\"\u003e\n \u003cp\u003eVertical incision\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"30.809859154929576%\" valign=\"top\"\u003e\n \u003cp\u003e(grand) total\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"38.38028169014085%\" valign=\"top\"\u003e\n \u003cp\u003e16（100%）\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"44.529262086513995%\" valign=\"top\"\u003e\n \u003cp\u003etop\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"55.470737913486005%\" valign=\"top\"\u003e\n \u003cp\u003e4（25%）\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"44.529262086513995%\" valign=\"top\"\u003e\n \u003cp\u003einterlocutory\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"55.470737913486005%\" valign=\"top\"\u003e\n \u003cp\u003e4（25%）\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"44.529262086513995%\" valign=\"top\"\u003e\n \u003cp\u003ebottom\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"55.470737913486005%\" valign=\"top\"\u003e\n \u003cp\u003e8（50%）\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n\u003cp\u003eTable 6 \u0026nbsp;Linear regression relationship between lesion size and general patient information\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"930\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"12.365591397849462%\"\u003e\n \u003cp\u003eLesion size\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.580645161290322%\"\u003e\n \u003cp\u003ePost-operative length of stay\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.580645161290322%\"\u003e\n \u003cp\u003eIntraoperative bleeding\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.580645161290322%\"\u003e\n \u003cp\u003eSurgical time\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.580645161290322%\"\u003e\n \u003cp\u003eCA125\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.580645161290322%\"\u003e\n \u003cp\u003eIncubation period\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.580645161290322%\"\u003e\n \u003cp\u003eAge\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.150537634408602%\"\u003e\n \u003cp\u003eType of lesion\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"12.365591397849462%\"\u003e\n \u003cp\u003eR\u0026sup2;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.580645161290322%\"\u003e\n \u003cp\u003e0.1718\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.580645161290322%\"\u003e\n \u003cp\u003e0.1224\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.580645161290322%\"\u003e\n \u003cp\u003e0.2571\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.580645161290322%\"\u003e\n \u003cp\u003e0.092\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.580645161290322%\"\u003e\n \u003cp\u003e0.06455\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.580645161290322%\"\u003e\n \u003cp\u003e0.04178\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.150537634408602%\"\u003e\n \u003cp\u003e0.0806\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"12.365591397849462%\"\u003e\n \u003cp\u003eP-value\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.580645161290322%\"\u003e\n \u003cp\u003e0.00\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.580645161290322%\"\u003e\n \u003cp\u003e0.00\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.580645161290322%\"\u003e\n \u003cp\u003e0.00\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.580645161290322%\"\u003e\n \u003cp\u003e0.003\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.580645161290322%\"\u003e\n \u003cp\u003e0.007\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.580645161290322%\"\u003e\n \u003cp\u003e0.0292\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.150537634408602%\"\u003e\n \u003cp\u003e0.002\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;Table 7 \u0026nbsp;Comparison of imaging general patient data\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"27.160493827160494%\"\u003e\n \u003cp\u003eGeneral information\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.696649029982364%\"\u003e\n \u003cp\u003eUltrasound\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.282186948853617%\"\u003e\n \u003cp\u003eNuclear magnetic resonance (NMR)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.282186948853617%\"\u003e\n \u003cp\u003eSurgeries\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.57848324514991%\"\u003e\n \u003cp\u003eP\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"27.160493827160494%\"\u003e\n \u003cp\u003eMaximum lesion diameter (cm)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.696649029982364%\"\u003e\n \u003cp\u003e2.43\u0026plusmn;1.11\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.282186948853617%\"\u003e\n \u003cp\u003e2.53\u0026plusmn;1.07\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.282186948853617%\"\u003e\n \u003cp\u003e2.4\u0026plusmn;1.16\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.57848324514991%\"\u003e\n \u003cp\u003e0.961\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"27.160493827160494%\"\u003e\n \u003cp\u003eLesion depth\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.696649029982364%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.282186948853617%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.282186948853617%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.57848324514991%\"\u003e\n \u003cp\u003e0.02\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"27.160493827160494%\"\u003e\n \u003cp\u003eFascial type (cases)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.696649029982364%\"\u003e\n \u003cp\u003e6（23.5%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.282186948853617%\"\u003e\n \u003cp\u003e1（5.9%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.282186948853617%\"\u003e\n \u003cp\u003e2（11.8%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.57848324514991%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"27.160493827160494%\"\u003e\n \u003cp\u003eRectus abdominis muscle (cases)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.696649029982364%\"\u003e\n \u003cp\u003e10（70.6%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.282186948853617%\"\u003e\n \u003cp\u003e10（58.8%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.282186948853617%\"\u003e\n \u003cp\u003e10（58.8%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.57848324514991%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"27.160493827160494%\"\u003e\n \u003cp\u003ePeritoneal type (cases)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.696649029982364%\"\u003e\n \u003cp\u003e1（5.9%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.282186948853617%\"\u003e\n \u003cp\u003e6（35.3%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.282186948853617%\"\u003e\n \u003cp\u003e5（29.4%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.57848324514991%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"27.160493827160494%\"\u003e\n \u003cp\u003eNumber of lesions\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.696649029982364%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.282186948853617%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.282186948853617%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.57848324514991%\"\u003e\n \u003cp\u003e0.382\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"27.160493827160494%\"\u003e\n \u003cp\u003eSingle-shot\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.696649029982364%\"\u003e\n \u003cp\u003e15（88.2%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.282186948853617%\"\u003e\n \u003cp\u003e12（70.6%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.282186948853617%\"\u003e\n \u003cp\u003e12（70.6%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.57848324514991%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"27.160493827160494%\"\u003e\n \u003cp\u003eFrequent\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.696649029982364%\"\u003e\n \u003cp\u003e2（11.8%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.282186948853617%\"\u003e\n \u003cp\u003e5（29.4%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.282186948853617%\"\u003e\n \u003cp\u003e5（29.4%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.57848324514991%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-womens-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bmwh","sideBox":"Learn more about [BMC Women's Health](http://bmcwomenshealth.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bmwh/default.aspx","title":"BMC Women's Health","twitterHandle":"","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Abdominal wall endometriosis, surgery, lesion typing","lastPublishedDoi":"10.21203/rs.3.rs-4558292/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-4558292/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eObjective \u003c/strong\u003eTo analyse and summarise the clinical characteristics, diagnosis, treatment and prognostic features of abdominal wall endometriosis.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods \u003c/strong\u003eA retrospective analysis of patients with abdominal wall endometriosis who attended Changzhou Second Hospital of Nanjing Medical University from January 2013 to December 2022 was performed. They were grouped according to the depth of infiltration of the lesion and the direction of incision, and the differences between the groups were compared.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults \u003c/strong\u003eA total of 228 patients with abdominal wall endometriosis were included in this study, including 210 cases with a history of abdominal transverse incision surgery, 16 cases with a history of vertical incision surgery, 1 case with a history of uterine fibroids surgery, 1 case with primary abdominal endometriosis, and 178 cases with the primary symptom of cyclic pain. They were classified as solitary and complex according to the number of lesions. Both were statistically significant for BMI, number of caesarean sections, operative time, bleeding and postoperative hospital stay (p\u0026lt;0.05). According to the depth of infiltration, they were divided into fascial, rectus abdominis and peritoneal types. There were differences between the three in latency time, CA125, maximum diameter of the lesion, operation time, bleeding and postoperative hospital stay (p\u0026lt;0.05). The direction of incision for caesarean section had no significant effect on the development of endometriosis in the abdominal wall or whether the lesions were multiple (p\u0026gt;0.05). On imaging, magnetic resonance imaging was more accurate for lesion typing.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion\u003c/strong\u003e AWE should be diagnosed early and treated surgically. The clinical manifestations of the same type are different, and CA125 test and abdominal wall ultrasound can be used preoperatively to determine lesion typing. Nuclear magnetic resonance (NMR) may be used to improve preoperative preparation for difficult diagnosis or staging.\u003c/p\u003e","manuscriptTitle":"Analysis of clinical factors in endometriosis of the abdominal wall","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-07-01 19:10:47","doi":"10.21203/rs.3.rs-4558292/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2024-08-05T17:07:42+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2024-08-02T16:24:31+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"284189567110097384469456771777775605311","date":"2024-07-11T10:17:29+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2024-06-28T20:55:42+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"245167607888355833698044643609799022419","date":"2024-06-28T20:36:58+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2024-06-21T16:39:40+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2024-06-11T12:14:52+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2024-06-11T00:12:48+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2024-06-11T00:12:35+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Women's Health","date":"2024-06-10T13:19:19+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-womens-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bmwh","sideBox":"Learn more about [BMC Women's Health](http://bmcwomenshealth.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bmwh/default.aspx","title":"BMC Women's Health","twitterHandle":"","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"9fd0232a-cdb9-4ee2-9c04-6ceac982ed25","owner":[],"postedDate":"July 1st, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2025-03-24T16:01:29+00:00","versionOfRecord":{"articleIdentity":"rs-4558292","link":"https://doi.org/10.1186/s12905-025-03660-z","journal":{"identity":"bmc-womens-health","isVorOnly":false,"title":"BMC Women's Health"},"publishedOn":"2025-03-22 15:57:35","publishedOnDateReadable":"March 22nd, 2025"},"versionCreatedAt":"2024-07-01 19:10:47","video":"","vorDoi":"10.1186/s12905-025-03660-z","vorDoiUrl":"https://doi.org/10.1186/s12905-025-03660-z","workflowStages":[]},"version":"v1","identity":"rs-4558292","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-4558292","identity":"rs-4558292","version":["v1"]},"buildId":"WvIrzKhiLBfengagbw6Ux","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}