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剖宫产瘢痕缺损的患病率、定义、病因及剖宫产瘢痕疾病的治疗:一项叙述性综述。

Prevalence, definition, and etiology of cesarean scar defect and treatment of cesarean scar disorder: A narrative review.

作者信息

Tsuji Shunichiro, Nobuta Yuri, Hanada Tetsuro, Takebayashi Aike, Inatomi Ayako, Takahashi Akimasa, Amano Tsukuru, Murakami Takashi

机构信息

Department of Obstetrics and Gynecology Shiga University of Medical Science Otsu Shiga Japan.

出版信息

Reprod Med Biol. 2023 Aug 9;22(1):e12532. doi: 10.1002/rmb2.12532. eCollection 2023 Jan-Dec.

Abstract

BACKGROUND

Cesarean scar defects (CSD) are caused by cesarean sections and cause various symptoms. Although there has been no previous consensus on the name of this condition for a long time, it has been named cesarean scar disorder (CSDi).

METHODS

This review summarizes the definition, prevalence, and etiology of CSD, as well as the pathophysiology and treatment of CSDi. We focused on surgical therapy and examined the effects and procedures of laparoscopy, hysteroscopy, and transvaginal surgery.

MAIN FINDINGS

The definition of CSD was proposed as an anechoic lesion with a depth of at least 2 mm because of the varied prevalence, owing to the lack of consensus. CSD incidence depends on the number of times, procedure, and situation of cesarean sections. Histopathological findings in CSD are fibrosis and adenomyosis, and chronic inflammation in the uterine and pelvic cavities decreases fertility in women with CSDi. Although the surgical procedures are not standardized, laparoscopic, hysteroscopic, and transvaginal surgeries are effective.

CONCLUSION

The cause and pathology of CSDi are becoming clear. However, there is variability in the prevalence and treatment strategies. Therefore, it is necessary to conduct further studies using the same definitions.

摘要

背景

剖宫产瘢痕缺陷(CSD)由剖宫产引起,并导致各种症状。尽管长期以来对此病症的名称一直没有达成共识,但现在已将其命名为剖宫产瘢痕疾病(CSDi)。

方法

本综述总结了CSD的定义、患病率和病因,以及CSDi的病理生理学和治疗方法。我们重点关注手术治疗,并研究了腹腔镜手术、宫腔镜手术和经阴道手术的效果及操作过程。

主要发现

由于缺乏共识,CSD的患病率各不相同,因此其定义被提议为深度至少为2毫米的无回声病变。CSD的发生率取决于剖宫产的次数、手术方式和情况。CSD的组织病理学表现为纤维化和子宫腺肌病,子宫和盆腔内的慢性炎症会降低患有CSDi的女性的生育能力。尽管手术操作尚未标准化,但腹腔镜手术、宫腔镜手术和经阴道手术均有效。

结论

CSDi的病因和病理正在逐渐明晰。然而,患病率和治疗策略存在差异。因此,有必要使用相同的定义进行进一步研究。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/40c9/10412910/ae4228bdc0d2/RMB2-22-e12532-g004.jpg

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