剖宫产后子宫瘢痕憩室治疗方式的研究进展

doi:10.12280/gjfckx.20210316

摘要/Abstract

摘要：

子宫瘢痕憩室（cesarean scar diverticula,CSD）近年发病率增高,主要由剖宫产术后的子宫切口愈合不良引起,是剖宫产手术的主要远期并发症,可引起育龄期女性异常子宫出血、经期延长、慢性盆腔痛和不孕等。目前临床上CSD治疗方式众多,口服避孕药、左炔诺孕酮宫内节育器及中药等保守药物治疗可在一定程度上改善患者经期延长的症状,宫腔镜、腹腔镜、经阴道修复、宫腹腔镜联合和宫腔镜辅助经阴道修复等手术治疗是目前CSD的主要治疗方式,术后能改善患者症状,降低CSD合并继发性不孕及瘢痕妊娠的发生率,但目前仍缺乏统一的术式选择标准,手术方式的选择、手术治疗的效果也存在争议,有待进一步研究。综述了CSD治疗方式选择、具体手术方法、不同治疗方式之间的疗效区别等内容。

关键词: 剖宫产术, 子宫, 瘢痕, 憩室, 子宫出血, 不育,女（雌）性, 治疗, 预后

Abstract:

The incidence rate of cesarean section scar diverticulum, also known as previous cesarean scar diverticula (CSD), which is a major long-term complication of cesarean section, has been increased recently. It is mainly due to the poor healing of uterine incision after cesarean section. CSD has been reported to be associated with abnormal uterine bleeding, prolonged menstruation, chronic pelvic pain and infertility and many other symptoms. At present, clinically surgical approaches for CSD is numerous. Conservative drugs such as oral contraceptives, levonorgestrel intrauterine device and traditional Chinese medicine can improve the symptoms of patients with prolonged menstruation. Hysteroscopy, laparoscopy, transvaginal repair, hysteroscopy combined with laparoscopy, hysteroscopy assisted transvaginal repair and other surgical treatment are the main treatment methods for CSD, which can improve the symptoms of patients after operation and reduce the incidence of CSD combined with secondary infertility and scar pregnancy. However, there is still a lack of a unified selection standard of surgical methods. The choice of surgical methods and the effect of surgical treatment are also controversial and need further study. This paper will review the choice of treatment methods, specific surgical methods and the difference of curative effect between different treatment methods for uterine scar diverticulum.

Key words: Cesarean section, Uterus, Cicatrix, Diverticulum, Uterine hemorrhage, Infertility,female, Therapy, Prognosis

生蓉, 汪希鹏. 剖宫产后子宫瘢痕憩室治疗方式的研究进展[J]. 国际妇产科学杂志, 2021, 48(4): 390-394.

SHENG Rong, WANG Xi-peng. Research Progress on the Treatment of Cesarean Scar Diverticula[J]. Journal of International Obstetrics and Gynecology, 2021, 48(4): 390-394.

图/表 3

图1 宫腔镜治疗CSD的手术步骤示意图注：A为CSD矢状面;B为宫腔镜切除CSD近端及远端边缘; C为手术后子宫矢状面。

图2 腹腔镜治疗CSD的手术步骤示意图注：A为CSD矢状面;B为腹腔镜分离子宫膀胱粘连并下推膀胱;C为确定CSD位置及范围;D为腹腔镜下切除CSD;E为腹腔镜下缝合;F为手术后子宫矢状面。

图3 经阴道修复CSD的手术步骤示意图注：A为CSD矢状面;B为经阴道分离子宫膀胱间隙;C为确定CSD位置及范围;D为经阴道切除CSD;E为缝合;F为手术后子宫矢状面。

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