Ciebiera Michał, Ciebiera Magdalena, Czekańska-Rawska Magdalena, Jakiel Grzegorz
First Department of Obstetrics and Gynecology, Center of Postgraduate Medical Education, Warsaw, Poland.
Students' Scientific Association at the First Department of Obstetrics and Gynecology, Medical University of Warsaw, Warsaw, Poland.
Wideochir Inne Tech Maloinwazyjne. 2017;12(1):88-95. doi: 10.5114/wiitm.2017.66025. Epub 2017 Mar 3.
A cesarean section is the most frequently performed surgery in modern obstetrics. In case of an incorrect wound healing process there is a risk of a persistent uterine wall defect. Nowadays, due to the high frequency of cesarean sections, obstetricians have to deal with the threat of uterine rupture due to pathological wound healing. It has been proven that isthmocele can cause abnormal uterine bleeding (AUB), pelvic pain (PP), and secondary infertility (SI), and can be a place of improper pregnancy placement.
This article presents our experience with isthmocele treatment. We describe our diagnostic process scheme, method of corrective surgery and main therapeutic outcomes.
In this manuscript we present a single center's experience in isthmocele therapy. We have operated on 16 patients who suffered from abnormal uterine bleeding, pain disorders or secondary infertility possibly due to a cesarean scar defect.
The results obtained in our center are promising. In 9 of 11 (81.8%) women with abnormal bleeding we obtained complete resolution of symptoms. We had slightly worse results in the case of pelvic pain. In 4 (66.6%) of 6 patients the pain resolved completely. We have obtained 7 pregnancies in 11 (63.6%) patients operated on due to secondary infertility.
In our opinion, laparoscopic treatment seems to be currently one of the most effective methods in isthmocele therapy. Further investigation is necessary to determine the indications for surgery, suitable treatment strategies and appropriate care.
剖宫产是现代产科最常施行的手术。若伤口愈合过程不正确，存在持续性子宫壁缺损的风险。如今，由于剖宫产的高发生率，产科医生不得不应对因病理性伤口愈合导致子宫破裂的威胁。已证实子宫峡部憩室可引起异常子宫出血（AUB）、盆腔疼痛（PP）和继发性不孕（SI），且可能是妊娠着床异常的部位。
本文介绍我们治疗子宫峡部憩室的经验。我们描述了诊断流程方案、矫正手术方法及主要治疗结果。
在本手稿中，我们介绍了一个单中心治疗子宫峡部憩室的经验。我们对16例可能因剖宫产瘢痕缺损而患有异常子宫出血、疼痛障碍或继发性不孕的患者进行了手术。
我们中心取得的结果很有前景。在11例异常出血的女性中，有9例（81.8%）症状完全缓解。盆腔疼痛方面的结果稍差。6例患者中有4例（66.6%）疼痛完全缓解。因继发性不孕接受手术的11例患者中有7例（63.6%）成功怀孕。
我们认为，腹腔镜治疗目前似乎是子宫峡部憩室治疗中最有效的方法之一。有必要进一步研究以确定手术适应症、合适的治疗策略和恰当的护理措施。
