Stavridis Konstantinos, Balafoutas Dimitrios, Vlahos Nikos, Joukhadar Ralf
2nd Department of Obstetrics and Gynecology, "Aretaieion" University Hospital, Athens, Greece.
Department of Obstetrics and Gynecology, Spital Männedorf, 8708, Männedorf, Switzerland.
Arch Gynecol Obstet. 2025 Jan;311(1):13-24. doi: 10.1007/s00404-024-07880-w. Epub 2024 Dec 16.
The prevalence of uterine isthmocele, also known as a uterine niche, has risen in parallel with increasing cesarean section (CS) rates, affecting approximately 60% of women depending on their history of cesarean deliveries. This condition, now categorized as cesarean scar disorder (CSD) by the "Delphi consensus," is characterized by one primary or two secondary symptoms. Diagnosis can be made through transvaginal ultrasound, sonohysterography, hysteroscopy, or magnetic resonance imaging (MRI). Management of isthmocele may involve pharmacological or surgical interventions. This review aims to provide a thorough analysis of the surgical management options, focusing on postoperative symptom relief, intraoperative and postoperative complications, length of hospital stay, and impact on secondary infertility. PubMed was comprehensively searched for observational studies from inception to 07.08.2024. Surgical treatments include hysteroscopic resection, laparoscopic procedures, and vaginal approaches, all of which offer comparable symptom relief. However, the vaginal approach is associated with a longer hospital stay. The robotic-assisted approach shows promising results but lacks extensive data. Among surgical options, hysteroscopic treatment has the fewest complications but is generally avoided when residual myometrial thickness (RMT) is less than 3 mm. While many CSDs remain asymptomatic, and some women with uterine isthmocele may not wish to conceive, symptomatic patients or those desiring to conceive may benefit from surgical intervention. The choice of procedure should be based on individual patient characteristics, particularly RMT, to define the most appropriate surgical approach.
子宫峡部憩室，也称为子宫切口憩室，其患病率随着剖宫产率的上升而增加，根据剖宫产史不同，约60%的女性受其影响。根据“德尔菲共识”，这种情况现在被归类为剖宫产瘢痕疾病（CSD），其特征为一种主要症状或两种次要症状。诊断可通过经阴道超声、子宫输卵管造影、宫腔镜检查或磁共振成像（MRI）进行。子宫峡部憩室的治疗可能涉及药物或手术干预。本综述旨在对手术治疗方案进行全面分析，重点关注术后症状缓解、术中及术后并发症、住院时间以及对继发不孕的影响。对PubMed进行了全面检索，以查找从创刊到2024年8月7日的观察性研究。手术治疗包括宫腔镜切除术、腹腔镜手术和经阴道手术，所有这些手术在缓解症状方面效果相当。然而，经阴道手术的住院时间更长。机器人辅助手术显示出有前景的结果，但缺乏广泛的数据。在手术选择中，宫腔镜治疗的并发症最少，但当残余肌层厚度（RMT）小于3mm时，通常避免使用。虽然许多CSD无症状，一些子宫峡部憩室的女性可能不希望怀孕，但有症状的患者或希望怀孕的患者可能从手术干预中获益。手术方式的选择应基于个体患者特征，尤其是RMT，以确定最合适的手术方法。
