Higuchi Naofumi, Sako Yusuke, Shiota Kyoko, Hirata Tetsuya
Department of Obstetrics and Gynecology, St. Luke's International Hospital, Tokyo, JPN.
Cureus. 2024 Mar 25;16(3):e56922. doi: 10.7759/cureus.56922. eCollection 2024 Mar.
Cesarean scar disorder (CSDi) is a newly recognized cause of secondary infertility. Laparoscopic or hysteroscopic surgery is generally chosen for the surgical treatment of CSDi, depending on the residual myometrial thickness of the cesarean scar. Previously, hysteroscopic transcervical resection for CSDi (TCR-CSDi) has been reported to be a safe procedure, with no cases of postoperative cervical stenosis. Herein, we report a novel case of cervical stenosis after circumferential hysteroscopic TCR-CSDi of an extensive CSDi lesion. Notably, although no cervical stenosis was observed upon postoperative hysteroscopy one month postoperatively, cervical stenosis developed four months after the surgery; therefore, it is important to avoid circumferential resection and cauterization in patients with CSDi, even when abnormal blood vessels are present. Additionally, it is advisable to check for delayed cervical stenosis at least three weeks before embryo transfer in patients who have undergone TCR-CSDi.
剖宫产瘢痕疾病（CSDi）是继发性不孕的一种新认识到的病因。根据剖宫产瘢痕处残留肌层厚度，通常选择腹腔镜或宫腔镜手术来治疗CSDi。此前，有报道称宫腔镜下经宫颈剖宫产瘢痕切除术（TCR-CSDi）是一种安全的手术，没有术后宫颈狭窄的病例。在此，我们报告一例广泛CSDi病变经环形宫腔镜TCR-CSDi术后发生宫颈狭窄的新病例。值得注意的是，尽管术后1个月宫腔镜检查未发现宫颈狭窄，但术后4个月出现了宫颈狭窄；因此，对于CSDi患者，即使存在异常血管，也应避免环形切除和烧灼。此外，对于接受过TCR-CSDi的患者，建议在胚胎移植前至少3周检查是否存在延迟性宫颈狭窄。
