Jeremy B, Bonneau C, Guillo E, Paniel B J, Le Tohic A, Haddad B, Madelenat P
Service de gynécologie-obstétrique, université Paris-Est Créteil, CHI de Créteil, 40, avenue de Verdun, 94000 Créteil, France.
Gynecol Obstet Fertil. 2013 Oct;41(10):588-96. doi: 10.1016/j.gyobfe.2013.08.005. Epub 2013 Oct 4.
To study the effect of the surgical repair (isthmorraphy) of the large scar dehiscence after cesarean on symptoms and fertility for women who desire pregnancy.
In this retrospective study, 14 symptomatic patients, who desire a new pregnancy underwent a surgical repair by laparotomy, laparoscopic or vaginal technique. Five women experienced failure of Assistance Reproductive Technique (IVF or ICSI) for idiopathic secondary infertility. The dehiscent scars were evaluated by ultrasound, hysterography, hysteroscopy and magnetic resonance imaging.
Symptoms improvement was found in 92% of case. Ten pregnancy (71%) was obtained after surgical repair, 6 spontaneous and 4 after Assistance Reproductive Technique. Among the 5 women initially followed in the reproductive unit, 4 became pregnant, 3 after IVF or ICSI and 1 spontaneous. No operative complication occurred. The subsequent pregnancy was unremarkable with no uterine rupture.
Large scar defect after cesarean can take shape of a complete absent of the anterior wall of the uterus. No incident has been proved in this condition. There is a lack of data concerning these isthmocele. The experience of hysteroscopic repair cannot be applied to these real large diverticule of the scar cesarean. The results of this study suggest a link between the isthmocele and reversible symptoms after surgery. The first results concerning the subsequent fertility after surgical repair seem interesting
When a large scare defect (isthmocele) is found in symptomatic woman (pelvic pain, bleeding uterine, infertility), a surgical repair can be proposed, especially for woman who desire a new pregnancy.
研究剖宫产术后大瘢痕裂开的手术修复（峡部缝合术）对有妊娠意愿女性的症状及生育能力的影响。
在这项回顾性研究中，14名有症状且希望再次妊娠的患者接受了开腹、腹腔镜或经阴道技术的手术修复。5名女性因特发性继发性不孕经历了辅助生殖技术（体外受精或卵胞浆内单精子注射）失败。通过超声、子宫输卵管造影、宫腔镜检查和磁共振成像对裂开的瘢痕进行评估。
92%的病例症状得到改善。手术修复后有10例妊娠（71%），6例自然妊娠，4例经辅助生殖技术妊娠。最初在生殖科随访的5名女性中，4名怀孕，3例经体外受精或卵胞浆内单精子注射妊娠，1例自然妊娠。未发生手术并发症。后续妊娠情况良好，未发生子宫破裂。
剖宫产术后的大瘢痕缺损可表现为子宫前壁完全缺失。这种情况下未证实有不良事件发生。关于这些峡部憩室的数据较少。宫腔镜修复的经验不适用于这些真正的剖宫产大憩室。本研究结果提示峡部憩室与手术后可逆性症状之间存在关联。手术修复后关于后续生育能力的初步结果似乎很有意思。
当在有症状的女性（盆腔疼痛、子宫出血、不孕）中发现大瘢痕缺损（峡部憩室）时，可建议进行手术修复，尤其是对于有再次妊娠意愿的女性。
