剖宫产后子宫瘢痕憩室形成因素的研究进展

doi:10.12280/gjfckx.20200559

摘要/Abstract

摘要：

剖宫产后子宫瘢痕憩室（cesarean scar diverticula,CSD）是继发于剖宫产的一种妇科疾病,指剖宫产术后子宫切口肌层愈合不良,在子宫峡部出现突向浆膜层,并与宫腔相通的一个囊状缺陷,导致异常子宫出血、慢性盆腔痛、瘢痕妊娠、胎盘植入,甚至再次妊娠子宫破裂等严重并发症。目前CSD形成因素尚未完全阐明,可能与剖宫产切口位置、手术缝合、感染、妊娠合并症或并发症等多种因素相关。现对CSD形成因素进行综述,为减少CSD发生提供理论依据。

关键词: 剖宫产术, 子宫, 瘢痕, 憩室, 妊娠并发症, 剖宫产后子宫瘢痕憩室

Abstract:

Cesarean scar diverticula (CSD) is a new gynecological disease secondary to cesarean section. It refers to the poor healing of myometrium of uterine incision after cesarean section. A cystic defect protruding to the serosa layer in the isthmus of uterus and communicating with the uterine cavity leads to serious complications such as abnormal uterine bleeding, chronic pelvic pain, scar pregnancy, placenta implantation, and even uterine rupture in pregnancy again. At present, the formation factors of CSD have not been fully elucidated, which may be related to cesarean section incision position, surgical suture, infection, pregnancy complications or complications. This paper reviews the formation factors of CSD to provide theoretical basis for reducing the occurrence of CSD.

Key words: Cesarean section, Uterus, Cicatrix, Diverticulum, Pregnancy complications, Cesarean scar diverticula

韩乔, 周星辰, 汪希鹏. 剖宫产后子宫瘢痕憩室形成因素的研究进展[J]. 国际妇产科学杂志, 2021, 48(1): 95-98.

HAN Qiao, ZHOU Xing-chen, WANG Xi-peng. Research Progress on the Formation Factors of Cesarean Scar Diverticula[J]. Journal of International Obstetrics and Gynecology, 2021, 48(1): 95-98.

参考文献 27

[1]	Jordans I, de Leeuw RA, Stegwee SI, et al. Sonographic examination of uterine niche in non-pregnant women: a modified Delphi procedure[J]. Ultrasound Obstet Gynecol, 2019,53(1):107-115. doi: 10.1002/uog.19049. doi: 10.1002/uog.19049 pmid: 29536581
[2]	Jordans I, de Leeuw RL, Stegwee SI, et al. Niche definition and guidance for detailed niche evaluation[J]. Acta Obstet Gynecol Scand, 2019,98(10):1351-1352. doi: 10.1111/aogs.13623. doi: 10.1111/aogs.13623 pmid: 30989635
[3]	Vitale SG, Ludwin A, Vilos GA, et al. From hysteroscopy to laparoendoscopic surgery: what is the best surgical approach for symptomatic isthmocele? A systematic review and meta-analysis[J]. Arch Gynecol Obstet, 2020,301(1):33-52. doi: 10.1007/s00404-020-05438-0. pmid: 31989288
[4]	Rosa F, Perugin G, Schettini D, et al. Imaging findings of cesarean delivery complications: cesarean scar disease and much more[J]. Insights Imaging, 2019,10(1):98. doi: 10.1186/s13244-019-0780-0. doi: 10.1186/s13244-019-0780-0 pmid: 31549248
[5]	Tang X, Wang J, Du Y, et al. Caesarean scar defect: Risk factors and comparison of evaluation efficacy between transvaginal sonography and magnetic resonance imaging[J]. Eur J Obstet Gynecol Reprod Biol, 2019,242:1-6. doi: 10.1016/j.ejogrb.2019.09.001. doi: 10.1016/j.ejogrb.2019.09.001 pmid: 31520876
[6]	Nezhat C, Falik R, Li A. Surgical management of niche, isthmocele, uteroperitoneal fistula, or cesarean scar defect: a critical rebirth in the medical literature[J]. Fertil Steril, 2017,107(1):69-71. doi: 10.1016/j.fertnstert.2016.10.017. doi: 10.1016/j.fertnstert.2016.10.017 pmid: 27865447
[7]	Zhou D, Wu F, Zhang Q, et al. Clinical outcomes of hysteroscopy-assisted transvaginal repair of cesarean scar defect[J]. J Obstet Gynaecol Res, 2020,46(2):279-285. doi: 10.1111/jog.14161. doi: 10.1111/jog.14161 pmid: 31960535
[8]	张艺馨, 杨清. 剖宫产瘢痕憩室及治疗方式选择[J]. 国际生殖健康/计划生育杂志, 2019,38(6):510-513. doi: 10.3969/j.issn.1674-1889.2019.06.016.
[9]	Antila-Långsjö RM, Mäenpää JU, Huhtala HS, et al. Cesarean scar defect: a prospective study on risk factors[J]. Am J Obstet Gynecol, 2018, 219(5):458.e1-458.e8. doi: 10.1016/j.ajog.2018.09.004. doi: 10.1016/j.ajog.2018.09.004
[10]	Osser OV, Jokubkiene L, Valentin L. High prevalence of defects in Cesarean section scars at transvaginal ultrasound examination[J]. Ultrasound Obstet Gynecol, 2009,34(1):90-97. doi: 10.1002/uog.6395. doi: 10.1002/uog.6395 pmid: 19499514
[11]	Chen Y, Han P, Wang YJ, et al. Risk factors for incomplete healing of the uterine incision after cesarean section[J]. Arch Gynecol Obstet, 2017,296(2):355-361. doi: 10.1007/s00404-017-4417-6. doi: 10.1007/s00404-017-4417-6 pmid: 28589479
[12]	Vikhareva Osser O, Valentin L. Risk factors for incomplete healing of the uterine incision after caesarean section[J]. BJOG, 2010,117(9):1119-1126. doi: 10.1111/j.1471-0528.2010.02631.x. pmid: 20604776
[13]	Chen H, Wang H, Zhou J, et al. Vaginal Repair of Cesarean Section Scar Diverticula Diagnosed in Non-pregnant Women[J]. J Minim Invasive Gynecol, 2019,26(3):526-534. doi: 10.1016/j.jmig.2018.06.012. doi: 10.1016/j.jmig.2018.06.012 pmid: 29944931
[14]	Zhou X, Yao M, Zhou J, et al. Defect width: the prognostic index for vaginal repair of cesarean section diverticula[J]. Arch Gynecol Obstet, 2017,295(3):623-630. doi: 10.1007/s00404-016-4245-0. doi: 10.1007/s00404-016-4245-0 pmid: 27885429
[15]	Vikhareva O, Rickle GS, Lavesson T, et al. Hysterotomy level at Cesarean section and occurrence of large scar defects: a randomized single-blind trial[J]. Ultrasound Obstet Gynecol, 2019,53(4):438-442. doi: 10.1002/uog.20184. doi: 10.1002/uog.20184 pmid: 30484920
[16]	Häger RM, Daltveit AK, Hofoss D, et al. Complications of cesarean deliveries: rates and risk factors[J]. Am J Obstet Gynecol, 2004,190(2):428-434. doi: 10.1016/j.ajog.2003.08.037. doi: 10.1016/j.ajog.2003.08.037 pmid: 14981385
[17]	Buhimschi CS, Buhimschi IA, Yu C, et al. The effect of dystocia and previous cesarean uterine scar on the tensile properties of the lower uterine segment[J]. Am J Obstet Gynecol, 2006,194(3):873-883. doi: 10.1016/j.ajog.2005.09.004. doi: 10.1016/j.ajog.2005.09.004 pmid: 16522428
[18]	Pan H, Zeng M, Xu T, et al. The prevalence and risk predictors of cesarean scar defect at 6 weeks postpartum in Shanghai,China: A prospective cohort study[J]. Acta Obstet Gynecol Scand, 2019,98(4):413-422. doi: 10.1111/aogs.13505. doi: 10.1111/aogs.13505 pmid: 30444954
[19]	Cai Y, Pan H, Zhang J, et al. Efficacy of adjunctive azithromycin versus single-dose cephalosporin prophylaxis for caesarean scar defect: study protocol for a randomised controlled trial[J]. BMJ Open, 2020,10(1):e032379. doi: 10.1136/bmjopen-2019-032379. doi: 10.1136/bmjopen-2019-032379 pmid: 31915163
[20]	Tita ATN, Boggess K, Saade G. Adjunctive Azithromycin Prophylaxis for Cesarean Delivery[J]. N Engl J Med, 2017,376(2):182. doi: 10.1056/NEJMc1614626. doi: 10.1056/NEJMc1614626 pmid: 28076707
[21]	Hanacek J, Vojtech J, Urbankova I, et al. Ultrasound cesarean scar assessment one year postpartum in relation to one- or two-layer uterine suture closure[J]. Acta Obstet Gynecol Scand, 2020,99(1):69-78. doi: 10.1111/aogs.13714. doi: 10.1111/aogs.13714 pmid: 31441500
[22]	Sholapurkar SL. Etiology of Cesarean Uterine Scar Defect (Niche): Detailed Critical Analysis of Hypotheses and Prevention Strategies and Peritoneal Closure Debate[J]. J Clin Med Res, 2018,10(3):166-173. doi: 10.14740/jocmr3271w. doi: 10.14740/jocmr3271w pmid: 29416572
[23]	Businaro R, Scaccia E, Bordin A, et al. Platelet Lysate-Derived Neuropeptide y Influences Migration and Angiogenesis of Human Adipose Tissue-Derived Stromal Cells[J]. Sci Rep, 2018,8(1):14365. doi: 10.1038/s41598-018-32623-8. pmid: 30254326
[24]	Capoano R, Businaro R, Tesori MC, et al. Wounds Difficult to Heal: An Effective Treatment Strategy[J]. Curr Vasc Pharmacol, 2017,15(6):582-588. doi: 10.2174/1570161115666170301122216. doi: 10.2174/1570161115666170301122216 pmid: 28260516
[25]	Hirt PA, Castillo DE, Yosipovitch G, et al. Skin changes in the obese patient[J]. J Am Acad Dermatol, 2019,81(5):1037-1057. doi: 10.1016/j.jaad.2018.12.070. doi: 10.1016/j.jaad.2018.12.070 pmid: 31610857
[26]	Beyene RT, Derryberry SL Jr, Barbul A. The Effect of Comorbidities on Wound Healing[J]. Surg Clin North Am, 2020,100(4):695-705. doi: 10.1016/j.suc.2020.05.002. doi: 10.1016/j.suc.2020.05.002 pmid: 32681870
[27]	Zhou X, Yang X, Chen H, et al. Obstetrical outcomes after vaginal repair of caesarean scar diverticula in reproductive-aged women[J]. BMC Pregnancy Childbirth, 2018,18(1):407. doi: 10.1186/s12884-018-2015-7. pmid: 30340551