Delaine M, Lecointre L, Akladios C Y, Hummel M, Host A, Garbin O
Unité de chirurgie gynécologique, pôle de gynécologie obstétrique, hôpitaux universitaires de Strasbourg, Strasbourg, France.
Unité de chirurgie gynécologique, pôle de gynécologie obstétrique, hôpitaux universitaires de Strasbourg, Strasbourg, France.
Gynecol Obstet Fertil Senol. 2017 May;45(5):262-268. doi: 10.1016/j.gofs.2017.03.007. Epub 2017 May 2.
To study the effects of laparoscopic repair of isthmoceles acquired after a cesarean section on symptoms and fertility.
This retrospective case series study included symptomatic women (abnormal uterine bleeding and/or pelvic pain and/or infertility) suffering from a large isthmocele and treated laparoscopically in our center. The surgical procedure consisted in resecting the pouch and suturing the scar in 2 layers. The patient follow-up has been realised through the postoperative control, the medical file and a survey, and concerned the evolution of the symptoms and fertility.
Nine patients have been included, all suffering from large isthmoceles, diagnosed by transvaginal ultrasound associated with hysteroscopy, hysterosalpingography or MRI. Postoperatively, the symptoms disappeared in 78% of the patients. There have been 4 spontaneous pregnancies in 4 patients, 3 of them had been diagnosed with infertility. The median patient medical follow-up lasted 28 months.
The diagnosis of a large isthmocele in patients suffering from invalidant symptoms and infertility should lead to consider a surgical treatment which is an efficient and surgically safe procedure.
研究剖宫产术后获得性峡部裂孔的腹腔镜修复对症状和生育能力的影响。
本回顾性病例系列研究纳入了在本中心接受腹腔镜治疗的有症状女性（异常子宫出血和/或盆腔疼痛和/或不孕），这些女性患有较大的峡部裂孔。手术步骤包括切除袋状组织并分两层缝合瘢痕。通过术后检查、病历和一项调查对患者进行随访，内容涉及症状和生育能力的演变。
纳入9例患者，均患有较大的峡部裂孔，通过经阴道超声联合宫腔镜检查、子宫输卵管造影或磁共振成像诊断。术后，78%的患者症状消失。4例患者中有4次自然妊娠，其中3例曾被诊断为不孕。患者的中位医学随访时间为28个月。
对于有无效症状和不孕的患者，诊断为较大的峡部裂孔时应考虑手术治疗，这是一种有效且手术安全的方法。
