Wang Shengke, Wang Dongdong
Department of Obstetrics and Gynecology, Shengjing Hospital of China Medical University, Shenyang, People's Republic of China.
Department of Obstetrics and Gynecology, Shengjing Hospital of China Medical University, Shenyang, People's Republic of China.
Am J Obstet Gynecol. 2025 Mar;232(3):332-335. doi: 10.1016/j.ajog.2024.10.003. Epub 2024 Oct 10.
In 1995, Morris first described cesarean scar defect as an "isthmocele" by macroscopy following hysterectomy in women with prior cesarean delivery. Cesarean scar defect is associated with gynecological symptoms such as abnormal uterine bleeding, secondary infertility, pelvic pain, and obstetrical complications such as cesarean scar pregnancy, placenta accreta, and uterine rupture. Surgical treatment techniques include hysteroscopic resection, transabdominal repair (laparotomy, laparoscopic, and robotic), and vaginal repair. If the residual myometrial thickness is <3 mm and a patient is symptomatic, consideration is made for defect repair from above rather than hysteroscopic resection. The advantages of laparoscopic repair include anatomic restoration of myometrial thickness, correction of uterine retroflexion, exploration of other causes of infertility and pelvic pain, and pathological diagnosis of scar tissue with endometriosis. Cesarean scar defect often cannot be visualized on the side of the abdominal cavity; therefore, it is difficult to identify the extent of the defect laparoscopically. Herein, we introduce laparoscopic cesarean scar defect repair through a surgical video with narration. This technique uses a uterine manipulator to distend and help delineate the defect, and a laparoscopic support suture within the defect as a "handle" to place the scar tissue on tension to ensure complete resection of the fibrotic tissue. Temporary uterine artery occlusion can be included to reduce bleeding in the surgical field to support visualization for complete fibrotic tissue removal and to achieve good apposition with a double-layer suture to promote proper anatomic wound healing. Symptom relief was achieved, and the patient became pregnant one year postoperatively. This video demonstrated a feasible, safe, effective procedure for laparoscopic cesarean scar defect repair in the patient.
1995年，莫里斯首次在对有剖宫产史的女性进行子宫切除术后，通过肉眼观察将剖宫产瘢痕缺损描述为“峡部膨出”。剖宫产瘢痕缺损与妇科症状相关，如异常子宫出血、继发性不孕、盆腔疼痛，以及产科并发症，如剖宫产瘢痕妊娠、胎盘植入和子宫破裂。手术治疗技术包括宫腔镜切除术、经腹修复（剖腹术、腹腔镜手术和机器人手术）以及经阴道修复。如果残余肌层厚度<3mm且患者有症状，则考虑从上方进行缺损修复而非宫腔镜切除术。腹腔镜修复的优点包括恢复肌层厚度的解剖结构、纠正子宫后屈、探查不孕和盆腔疼痛的其他原因，以及对瘢痕组织进行子宫内膜异位症的病理诊断。剖宫产瘢痕缺损在腹腔一侧通常无法可视化；因此，很难通过腹腔镜确定缺损的范围。在此，我们通过一段配有旁白的手术视频介绍腹腔镜剖宫产瘢痕缺损修复术。该技术使用子宫操纵器来扩张并帮助勾勒缺损，在缺损内放置腹腔镜支撑缝线作为“把手”，使瘢痕组织处于张力状态，以确保完全切除纤维化组织。可包括临时子宫动脉闭塞以减少手术视野出血，以支持可视化以完全切除纤维化组织，并通过双层缝合实现良好对合，以促进正确的解剖伤口愈合。症状得到缓解，患者术后一年怀孕。该视频展示了一种可行、安全、有效的腹腔镜剖宫产瘢痕缺损修复手术方法。
