Born Tilman, Krejci Katrin, Rauh Maximilian, Cole Georgia, Kappelmeyer Maurice, Vural Mehmet, Köninger Angela
Department of Gynecology and Obstetrics, University of Regensburg, Clinic St. Hedwig, Steinmetzstrasse 1-3, Regensburg 93049, Germany.
Eur J Obstet Gynecol Reprod Biol X. 2025 Mar 31;26:100386. doi: 10.1016/j.eurox.2025.100386. eCollection 2025 Jun.
Uterine scar defects result from poor healing of the hysterotomy after cesarean sections (CS), in multiple cases leading to retroflexio uteri and retrograde menstruation. Endometriosis is the probable consequence. Patients often experience overlapping symptoms such as dysmenorrhea, dyspareunia, and infertility.
This study analysed cases of sonographically detected uterine scar defects, subsequently undergoing laparoscopy at the University Clinic St. Hedwig, in Regensburg, between 2020 and 2024. Herefore, surgery reports were reviewed, focusing on extragenital endometriosis, symptoms of Cesarean Scar Disorder (CSD), niche morphology, uterine position, and endometriosis localisation using the #Enzian classification.
Extragenital endometriosis was histologically confirmed in 45 of 94 patients (47.9 %) with symptomatic or large uterine niches. A significant association was found between endometriosis and heavy menstrual bleeding (HMB) (p < 0.001) as well as retroflexio uteri (p = 0.036). Symptoms related to CSD did not differ in patients with or without Endometriosis. Endometriotic implants were primarily located in the peritoneum behind the uterus and sacrouterine ligaments, supporting the hypothesis of retrograde menstruation.
There is significant overlap between the symptoms of endometriosis and CSD. Almost half of the patients with a symptomatic niche were found to have endometriosis, whereby the location of endometriosis supports the hypothesis of retrograde menstruation. However, the patient´s history of complaints is not indicative of the diagnosis of endometriosis. Therefore, all patients with CSD should be offered a laparoscopy and endometriosis surgery. All patients with a previous caesarean section presenting with symptoms of endometriosis should be offered standardised and high-quality niche diagnosis and treatment.
子宫瘢痕缺损是剖宫产术后子宫切口愈合不良所致，在多例病例中会导致子宫后屈和逆行性月经。子宫内膜异位症可能是其后果。患者常出现痛经、性交困难和不孕等重叠症状。
本研究分析了2020年至2024年间在雷根斯堡圣海德维希大学诊所经超声检查发现子宫瘢痕缺损并随后接受腹腔镜检查的病例。因此，回顾了手术报告，重点关注生殖器外子宫内膜异位症、剖宫产瘢痕疾病（CSD）的症状、切口形态、子宫位置以及使用恩齐安分类法的子宫内膜异位症定位。
94例有症状或大子宫切口的患者中，45例（47.9%）经组织学证实存在生殖器外子宫内膜异位症。子宫内膜异位症与月经过多（HMB）（p<0.001）以及子宫后屈（p=0.036）之间存在显著关联。有或无子宫内膜异位症的患者与CSD相关的症状并无差异。子宫内膜异位植入物主要位于子宫后方的腹膜和骶子宫韧带，支持逆行性月经的假说。
子宫内膜异位症和CSD的症状有显著重叠。发现几乎一半有症状切口的患者患有子宫内膜异位症，其中子宫内膜异位症的位置支持逆行性月经的假说。然而，患者的主诉病史并不能指示子宫内膜异位症的诊断。因此，所有CSD患者都应接受腹腔镜检查和子宫内膜异位症手术。所有有剖宫产史且出现子宫内膜异位症症状的患者都应接受标准化和高质量的切口诊断与治疗。
