Li Changdong, Guo Yinshu, Liu Yun, Cheng Jiumei, Zhang Weiyuan
J Perinat Med. 2014 May;42(3):363-70. doi: 10.1515/jpm-2013-0081.
To examine the treatment of previous cesarean delivery scar defect after cesarean delivery and the feasibility of laparoscopic uterine repair or hysteroscopic scar excision.
A retrospective clinical study that took place from June 2009 to March 2013 and included 41 women who had previously had cesarean deliveries.
Seventeen women underwent a laparoscopic approach for the repair of scar diverticula, and 24 women underwent a hysteroscopic resection of fibrotic tissue overhanging underneath the diverticula. Most women remained free of symptoms over a 3- to 16-month follow-up and 6 women became pregnant without pregnancy complications.
Women with a history of cesarean delivery combined with irregular perimenstrual bleeding should undergo combined hysteroscopy and ultrasound examination to detect latent scar defects. In diagnosed cases, in those who desired future pregnancies and had a residual myometrial thickness of <3.5 mm or a defect that accounted for ≥50% of the anterior uterine wall, laparoscopic surgical repair was performed with good postoperative anatomic outcomes. Women with residual myometrial thickness of ≥3.5 mm or a defect that accounted for <50% of the anterior uterine wall were treated with hysteroscopic surgery and had a relief of symptoms.
探讨剖宫产术后子宫瘢痕憩室的治疗方法以及腹腔镜子宫修复术或宫腔镜瘢痕切除术的可行性。
一项回顾性临床研究，时间跨度为2009年6月至2013年3月，纳入41例既往有剖宫产史的女性。
17例女性接受了腹腔镜下瘢痕憩室修复术，24例女性接受了宫腔镜下切除憩室下方突出的纤维化组织。在3至16个月的随访中，大多数女性症状消失，6例女性成功怀孕且无妊娠并发症。
有剖宫产史且月经周期不规则伴出血的女性应接受宫腔镜联合超声检查以发现潜在的瘢痕缺陷。对于确诊病例，有未来妊娠意愿且子宫肌层残余厚度<3.5 mm或缺陷占子宫前壁≥50%的患者，行腹腔镜手术修复，术后解剖学效果良好。子宫肌层残余厚度≥3.5 mm或缺陷占子宫前壁<50%的女性接受宫腔镜手术治疗，症状得到缓解。
