Department of Pediatrics, Obstetrics and Reproductive Medicine, Section of Obstetrics and Gynecology, University of Siena, Siena, Italy.
Curr Opin Obstet Gynecol. 2012 Jun;24(3):180-6. doi: 10.1097/GCO.0b013e3283521202.
To review the treatments of the cesarean-induced isthmocele in restoring infertility, associated techniques, and the risks of complications associated with their use.
Isthmocele is a reservoir-like pouch defect on the anterior wall of the uterine isthmus located at the site of a previous cesarean delivery scar. The flow of menstrual blood through the cervix may be slowed by the presence of isthmocele, as the blood may accumulate in the niche because of the presence of fibrotic tissue, causing pelvic pain in the suprapubic area. Moreover, persistence of the menstrual blood after menstruation in the cervix may negatively influence the mucus quality and sperm quality, obstruct sperm transport through the cervical canal, interfere with embryo implantation, leading to secondary infertility. The removal of the local inflamed tissue may be performed by laparoscopic, combined laparoscopic-vaginal, or vaginal surgery, and operative hysteroscopy, a minimally invasive approach to improve symptoms and restore fertility.
Isthmocele occurs after cesarean section, a common method of delivery and one of the most frequent surgical procedures, so that its upward incidence appears likely to continue in the near future. Because of its minimal invasiveness, resectoscopy may be the better choice for treatment, yielding good therapeutic results.
回顾剖宫产导致的子宫峡部憩室在治疗不孕中的治疗方法、相关技术，以及与使用相关技术有关的并发症风险。
子宫峡部憩室是剖宫产术后子宫峡部前壁的一种类似囊袋的缺陷。由于存在纤维组织，憩室可能会导致经血在小窝中积聚，从而减缓经血通过宫颈的流动，导致耻骨上方盆腔疼痛。此外，月经后宫颈内的经血持续存在可能会对黏液质量和精子质量产生负面影响，阻碍精子通过宫颈管的运输，干扰胚胎着床，导致继发性不孕。可以通过腹腔镜、联合腹腔镜-阴道或阴道手术以及宫腔镜手术切除局部炎症组织，这是一种微创方法，可以改善症状并恢复生育能力。
剖宫产术后会发生子宫峡部憩室，这是一种常见的分娩方式，也是最常见的手术之一，因此其发病率似乎很可能在不久的将来继续上升。由于其微创性，电切术可能是治疗的更好选择，可取得良好的治疗效果。
