Seyam Emaduldin, Ibrahim Emad Moussa, Youseff Ayman Moheb, Khalifa Eissa M, Hefzy Enas
Obstetrics and Gynecology Department, Minia University College of Medicine, Minya, Egypt.
Microbiology and Immunology Department, Fayoum University College of Medicine, Faiyum, Egypt.
Obstet Gynecol Int. 2018 Feb 1;2018:6901764. doi: 10.1155/2018/6901764. eCollection 2018.
The aim of the current study was to laparoscopically investigate the effects of peritoneal nonclosure on the sites, types, and degrees of adhesions developed after primary caesarean section (CS) in women complaining of secondary infertility after first CS delivery.
This was a cross-sectional study, where 250 women suffering from secondary infertility after their first CS had been recruited. They had been classified into group I ( = 89), where both the visceral and parietal peritoneum had been left opened; group II ( = 75), where only the parietal peritoneum had been closed; and group III ( = 86), where both peritoneal layers had been closed. Laparoscopy had been used to classify those adhesions according to the location, severity, and their adverse impact on the reproductive capacity.
Both adnexal and nonadnexal adhesions had been found significantly higher in group I, while adnexal types of adhesions were significantly higher after nonclosure of the visceral peritoneum in group II. Laparoscopic tubal surgery performed included tubo-ovariolysis, fimbrioplasty, and neosalpingostomy. Pregnancy rate was found correlating with the adnexal adhesion location and score.
Nonclosure of the peritoneum in CS is associated with more adhesion formation, which might adversely affect the future women reproduction.
本研究旨在通过腹腔镜检查，探究腹膜不闭合对首次剖宫产（CS）后出现继发性不孕的女性在原发性剖宫产术后粘连的部位、类型和程度的影响。
这是一项横断面研究，招募了250名首次剖宫产术后出现继发性不孕的女性。她们被分为三组：第一组（n = 89），脏腹膜和壁腹膜均敞开；第二组（n = 75），仅闭合壁腹膜；第三组（n = 86），两层腹膜均闭合。通过腹腔镜检查，根据粘连的位置、严重程度及其对生殖能力的不利影响对粘连进行分类。
第一组的附件粘连和非附件粘连均显著高于其他组，而在第二组中，脏腹膜不闭合后附件粘连类型显著更高。进行的腹腔镜输卵管手术包括输卵管卵巢松解术、伞端成形术和输卵管造口术。发现妊娠率与附件粘连的位置和评分相关。
剖宫产术中腹膜不闭合与更多粘连形成有关，这可能对未来女性的生殖产生不利影响。
