Bardet Lena, Berl Quentin, Debras Elodie, Pourcelot Anne-Gaelle, Fernandez Hervé, Capmas Perrine
Department of Gynecology and Obstetrics, Bicetre Hospital, Le Kremlin Bicetre, France (all authors).
Department of Gynecology and Obstetrics, Bicetre Hospital, Le Kremlin Bicetre, France (all authors); Faculty of Medicine, University Paris Saclay, Le Kremlin Bicetre, France (Drs. Fernandez and Capmas); Research Center in Epidemiology and Population Health (Drs. Fernandez and Capmas), U1018, Inserm, Villejuif, France.
J Minim Invasive Gynecol. 2025 Apr;32(4):352-357. doi: 10.1016/j.jmig.2024.10.023. Epub 2024 Dec 13.
To compare outcomes of vaginal surgery in women with moderate or severe symptomatic cesarean scar defect (with or without residual myometrium).
Retrospective cohort study.
Gynecology department of a teaching hospital.
Fifty-three women, between January 2014 and December 2019, underwent vaginal surgery for symptomatic cesarean scar defect: 20 women with moderate defect (with residual myometrium) and 33 with severe defect (without residual myometrium).
Vaginal surgical approach to repair cesarean scar defect.
surgery by comparing the myometrial residual thickness before and after surgery. The secondary objectives were evaluation of vaginal surgery efficacy on symptoms resolution, per and postoperative courses, and subsequent fertility. Failure rate was evaluated as the need for a second surgery. After vaginal surgery, the residual myometrium significantly increased from 2.4 mm ± 0.9 mm to 6.6 mm ± 2.4 mm (p <.01) in the moderate group and from 0 mm to 4.4 mm ± 2.2 mm (p <.01) in the severe group. The prevalence of abnormal uterine bleeding was significantly reduced after surgery in both groups (p <.01). Pelvic pain was significantly reduced only in the moderate group (p <.01). The rate of complications (5% vs 9.1%) and second surgery (15% vs 24.2%) were not significantly different between moderate and severe groups, respectively. The median time to conceive (7 months vs 12 months); pregnancy rates (84.6% vs 68.2%); and live birth rates (76.9% vs 50%) were not statistically significant in the moderate and severe groups respectively, with 90% of pregnancies occurring naturally. Women delivered by cesarean section at 38 weeks of gestation in both groups, and no uterine rupture was reported.
Despite the absence of residual myometrium, vaginal repair of severe cesarean scar defect was effective in increasing myometrial thickness, in relieving bleeding symptoms, and in allowing to achieve pregnancy.
比较有中度或重度症状性剖宫产瘢痕缺损（有无残留肌层）女性的阴道手术效果。
回顾性队列研究。
一家教学医院的妇科。
2014年1月至2019年12月期间，53名有症状性剖宫产瘢痕缺损的女性接受了阴道手术：20名中度缺损（有残留肌层）女性和33名重度缺损（无残留肌层）女性。
采用阴道手术方法修复剖宫产瘢痕缺损。
通过比较手术前后的肌层残留厚度评估手术效果。次要目标是评估阴道手术对症状缓解、围手术期及术后过程以及后续生育能力的疗效。失败率以是否需要二次手术来评估。阴道手术后，中度组的残留肌层厚度从2.4mm±0.9mm显著增加至6.6mm±2.4mm（p<.01），重度组从0mm增加至4.4mm±2.2mm（p<.01）。两组术后异常子宫出血的发生率均显著降低（p<.01）。仅中度组的盆腔疼痛显著减轻（p<.01）。中度组和重度组的并发症发生率（5%对9.1%）和二次手术率（15%对24.2%）分别无显著差异。中度组和重度组的中位受孕时间（7个月对12个月）、妊娠率（84.6%对68.2%）和活产率（76.9%对50%）分别无统计学差异，90%的妊娠为自然受孕。两组均在妊娠38周时行剖宫产分娩，未报告子宫破裂。
尽管没有残留肌层，但阴道修复重度剖宫产瘢痕缺损在增加肌层厚度、缓解出血症状以及实现妊娠方面是有效的。
