有生育要求的剖宫产瘢痕憩室患者的临床管理

doi:10.12280/gjfckx.20220003

摘要/Abstract

摘要：

剖宫产瘢痕憩室（cesarean scar diverticulum,CSD）作为剖宫产术后并发症之一,是由于剖宫产子宫切口瘢痕愈合不良所致。CSD主要的临床表现包括异常子宫出血、盆腔痛和继发性不孕等。CSD患者再妊娠时可能发生瘢痕妊娠、胎盘植入和子宫破裂等严重并发症。CSD的治疗方式众多,对于无明显临床症状的无生育要求、憩室较小的CSD患者,可选择保守治疗,如宫内缓释系统、避孕药和中药等。而手术治疗作为治疗CSD的主要手段,主要用于改善患者的临床症状、降低CSD合并继发不孕及复发性流产的发生风险。目前对于有生育要求的CSD患者,妊娠前是否需要治疗、治疗方式、妊娠时机及分娩方式等尚无统一意见。

关键词: 剖宫产术, 子宫, 瘢痕, 憩室, 剖宫产后阴道分娩, 子宫破裂

Abstract:

Cesarean scar diverticulum (CSD), as one of the complications after cesarean section, is caused by poor healing of uterine incision after cesarean section. The main clinical manifestations include abnormal uterine bleeding, pelvic pain and secondary infertility. Severe complications such as scar pregnancy, placental implantation and uterine rupture may occur during the following pregnancy. There are many treatment methods for CSD. Conservative treatment (such as intrauterine sustained release system, contraceptive, Traditional Chinese Medicine, etc.) can be used for small CSD patients with no fertility requirements and no obvious clinical symptoms. As the main method of CSD treatment, surgical treatment is mainly used to improve the clinical symptoms of patients, and reduce the occurrence of CSD complicated with secondary infertility and recurrent abortion. At present, there is no unified opinion on the need for treatment, treatment, opportunity of pregnancy and mode of delivery for CSD patients with fertility requirements.

Key words: Cesarean section, Uterus, Cicatrix, Diverticulum, Vaginal birth after cesarean, Uterine rupture

刘广谱, 张惠欣. 有生育要求的剖宫产瘢痕憩室患者的临床管理[J]. 国际妇产科学杂志, 2022, 49(4): 430-433.

LIU Guang-pu, ZHANG Hui-xin. Clinical Management of Patients with Cesarean Scar Diverticulum with Fertility Requirements[J]. Journal of International Obstetrics and Gynecology, 2022, 49(4): 430-433.

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