Klemm Petra, Koehler Christhardt, Mangler Mandy, Schneider Uwe, Schneider Achim
Department of Gynecology, Friedrich-Schiller-University Jena, Germany.
J Perinat Med. 2005;33(4):324-31. doi: 10.1515/JPM.2005.058.
Cesarean section (CS) is the most common operation in obstetrics, with rising incidence in most countries. As a result of this operation late scar dehiscence may occur, which may lead to uterine rupture in a subsequent pregnancy. In this case series we have described sonographic detection of scar dehiscence after CS and feasibility of vaginal or combined laparoscopic and vaginal scar excision and uterine repair.
Five consecutive patients underwent vaginal or laparoscopic assisted vaginal approach for repair of suspected scar dehiscence following CS, during a 5 year period. In all cases, transvaginal sonography detected suspicious features of scar dehiscence over the anterior uterine wall. Except of one, all patients had reported recurrent pelvic pain and/or irregular menstrual bleedings. Furthermore all patients planned for a further pregnancy.
Resection of the uterine defect and re-constitution of the uterine wall was successfully achieved in all five patients. There were no intra-operative complications and none of the patients required blood transfusion. The mean operation time was 117 min (27-192). Presence of scar tissue was confirmed on histology in all specimens. Four patients remained free of symptoms with no evidence of recurrent scar dehiscence on sonography over a median follow up of 30 months (3-46). One patient had an uneventful pregnancy 24 months after scar removal and was delivered by repeat CS at 39 weeks' gestation.
Patients with a history of CS should undergo transvaginal sonography of the scar region in order to detect latent scar dehiscence in combination with uterine wall thinning prior to planning further pregnancy. In suspected cases, a combined laparoscopic - vaginal or vaginal approach can be employed to repair the defect.
剖宫产是产科最常见的手术，在大多数国家其发生率呈上升趋势。该手术后可能会发生晚期瘢痕裂开，这可能导致再次妊娠时子宫破裂。在本病例系列中，我们描述了剖宫产术后瘢痕裂开的超声检测以及阴道或腹腔镜联合阴道瘢痕切除和子宫修复的可行性。
在5年期间，连续5例患者因怀疑剖宫产术后瘢痕裂开接受了阴道或腹腔镜辅助阴道修复手术。所有病例经阴道超声均检测到子宫前壁瘢痕裂开的可疑特征。除1例患者外，所有患者均有复发性盆腔疼痛和/或月经不规律出血。此外，所有患者均计划再次妊娠。
所有5例患者均成功切除子宫缺损并重建子宫壁。术中无并发症发生，所有患者均未输血。平均手术时间为117分钟（27 - 192分钟）。所有标本的组织学检查均证实有瘢痕组织存在。在中位随访30个月（3 - 46个月）期间，4例患者无症状，超声检查无瘢痕裂开复发迹象。1例患者在瘢痕切除术后24个月妊娠顺利，于妊娠39周时行再次剖宫产分娩。
有剖宫产史的患者在计划再次妊娠前应进行瘢痕区域的经阴道超声检查，以检测潜在的瘢痕裂开及子宫壁变薄情况。对于疑似病例，可采用腹腔镜联合阴道或阴道入路修复缺损。
