宫腔镜手术对剖宫产瘢痕综合征相关峡部憩室的影响。
Impact of hysteroscopic surgery for isthmocele associated with cesarean scar syndrome.
作者信息
Tsuji Shunichiro, Kimura Fuminori, Yamanaka Akiyoshi, Hanada Tetsuro, Hirata Kimiko, Takebayashi Akie, Takashima Akiko, Seko-Nitta Ayumi, Murakami Takashi
机构信息
Department of Obstetrics and Gynecology, Shiga University of Medical Science, Otsu City, Shiga, Japan.
Department of Radiology, Shiga University of Medical Science, Otsu City, Shiga, Japan.
出版信息
J Obstet Gynaecol Res. 2018 Jan;44(1):43-48. doi: 10.1111/jog.13464. Epub 2017 Sep 11.
AIM
Cesarean scar syndrome (CSS) is characterized by increased risk of postmenstrual abnormal uterine bleeding, dysmenorrhea, and infertility, due to a post-cesarean scar defect known as an isthmocele. This study aimed to assess the impact of hysteroscopic surgery on isthmocele associated with CSS.
METHODS
Eighteen patients with CSS were enrolled. Surgical methods included resection of the inferior edge and superficial cauterization of the isthmocele via hysteroscopic surgery. We evaluated the residual myometrial thickness and isthmocele volume using magnetic resonance imaging, before and after hysteroscopic surgery.
RESULTS
All patients underwent surgery without any complications. The residual myometrium was thicker after hysteroscopic surgery (median: 2.1 mm and 4.2 mm, before and after surgery, respectively; P = 0.0001). Isthmocele volume was significantly reduced after hysteroscopic surgery (median: 494.9 mm and 282.8 mm , before and after surgery, respectively; P = 0.0016).
CONCLUSION
This study demonstrated that hysteroscopic surgery is effective in increasing the residual myometrial thickness and reducing the size of isthmocele.
目的
剖宫产瘢痕综合征（CSS）的特征是，由于剖宫产瘢痕处存在峡部缺损（即子宫峡部憩室），经后期异常子宫出血、痛经和不孕的风险增加。本研究旨在评估宫腔镜手术对与CSS相关的子宫峡部憩室的影响。
方法
纳入18例CSS患者。手术方法包括通过宫腔镜手术切除子宫峡部憩室的下缘并进行表面烧灼。我们在宫腔镜手术前后，使用磁共振成像评估残余肌层厚度和子宫峡部憩室体积。
结果
所有患者均顺利接受手术，无任何并发症。宫腔镜手术后残余肌层更厚（术前和术后的中位数分别为2.1 mm和4.2 mm；P = 0.0001）。宫腔镜手术后子宫峡部憩室体积显著减小（术前和术后的中位数分别为494.9 mm³和282.8 mm³；P = 0.0016）。
结论
本研究表明，宫腔镜手术可有效增加残余肌层厚度并减小子宫峡部憩室的大小。
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