Clinical Analysis On 21 Cases Of Gynecologic Abdominal Cocoon

Objective:Discuss the incidence,clinical characteristics, diagnosis, treatment of gynecologic abdominal cocoon.Method:25 gynecologic abdominal cocoon patients were admitted in Qilu hospital of Shandong University during May 2005 to August 2015.2 patients were previously diagnosed with the disease.2 patients’data was incomplete. The clinical data of the rest 21 gynecologic abdominal cocoon is collected for retrospective analysis.50 ovarian cancer patients and 50 endometriosis of uterus patients who were received at the corresponding period are selected randomly as two control groups.The relevant data adopts SPSS 19.0 for statistical analysis. It is seemed to be statistically significant if P<0.05.The enumeration data adopts x2test or fisher exact probabilities;the measurement data adopts mean±tandard deviation (x±s) or median description, the comparison among 3 groups adopts one way analysis of variance or rank sum test and the comparison among groups adopts LSD test.Results:l.Age of onset:the visiting age of patients was 31.90 ± 7.48 years old and the age of onset is not statistically different with the endometriosis patients(P> 0.05) and is statistically different with the ovarian cancer patients (P<0.05).2.Clinical presentation:the major presentations are pelvic mass (6/21); infertility (10/21) menstrual disorder(2/21);abdominal pain (7/21) and weight loss(l/ 21) etc.Compared with the control groups,the sterility rate of gynecologic abdominal cocoon group is higher.3.Auxiliary examination and preoperative diagnosis:1 case was positive on tuberculin test;the positive rate of erythrocyte sedimentation rate was 1/3;21 patients had routine ultrasonic examination,6 patients presented pelvic mass and 2 accompanied with ascites,4 patients presented hydrosalpinx,2 patients presented ovarian cyst,1 patients presented ovarian tumor,1 patient presented pyosalpinx, 1 patient presented thickening endometrium,6 patients showed nothing abnormal.9 patients had routine CT examination,4 patients presented pelvic mass and 2 accompanied with ascites,1 patient presented pyosalpinx,1 patient presented ovarian teratoma,l patient presented endometrial carcinoma,2 patients showed nothing abnormal.All examinations before operation did not prompt for abdominal cocoon.The diagnosis rate in the operation was 100%. Compared with the control groups,the preoperative diagnosis rate of gynecologic abdominal cocoon group was very low.4.Treatment:All of the 21 patients had operations and were diagnosed as abdominal cocoon,in witch 6 cases accompanied by pelvic encapsulated effusion,4 cases accompanied by hydrosalpinx,4 cases accompanied by oviduct obstruction,1 case accompanied by pyosalpinx,2 cases accompanied by ovarian cyst,1 case accompanied by ovarian tumor,1 case accompanied by endometrial carcinoma.6 cases of encapsulated effusion were diagnosed as pelvic mass and had diagnostic operation.The fallopian tubes and ovaries of the 10 patients did not expose well during the operations. And none of them conceived naturally after therapy.Conclusions:1.The gynecologic abdominal cocoon mainly appears in the female during child—bearing period.2.The clinical presentation is not typical and the major presentations are infertility,pelvic mass, menstrual disorder and abdominal pain etc.3.There is no examination method both with high sensitivity and specificity.4.Most patients do not need surgical therapy, only a few complicated with gynecological diseases need surgical treatment. It is important to avoid blind surgery and excessive treatment.