协和医学杂志

2020, v.11(02) 191-195

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剖宫产瘢痕缺陷诊治进展
Progress in the Diagnosis and Treatment of Cesarean Scar Defect

张多多;郎景和;朱兰;
ZHANG Duo-duo;LANG Jing-he;ZHU Lan;Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College;

摘要(Abstract):

剖宫产后子宫下段切口愈合不良可形成憩室样结构,即瘢痕缺陷,一般指剩余肌层厚度<3 mm或<50%毗邻肌层厚度的子宫下段肌层缺损。这种缺损对于未孕妇女可引起经期延长、淋漓不尽,偶可引起疼痛或不孕症状;妊娠者则有发生憩室内剖宫产瘢痕妊娠、子宫破裂的风险。经阴道超声诊断方便、准确,已成为瘢痕缺陷的主要诊断方式,而磁共振成像及宫腔镜则能进一步提供更加详细的诊断信息。大部分患者并无症状,常见的治疗目的是缩短淋漓不尽的月经出血。少量研究提示口服避孕药一定程度上可改善症状;宫腔镜热消融缺损部位内膜或开渠重建憩室流出道疗效确切,但不适用于肌层过薄或有再生育要求的患者;腹腔镜、阴式瘢痕缺陷修补术不仅可改善症状,还能显著增加下段瘢痕厚度,目前已成为常见的重建手术方式。
A niche-shaped myometrium defect can be noticed after the cesarean procedure, which is defined as the thickness of the remaining myometrium <3 mm or <50% of the adjacent myometrium. The leading symptom of patients with cesarean scar defect is long-lasting spotting following a normal menstrual period; dysmenorrhea and infertility are relatively rare symptoms.Pregnancy in the niche of the cesarean scar and uterine rupture are much more severe complications happening in the conceived patients. The transvaginal sonography is most widely used for diagnosis due to its convenience and accuracy, which along with magnetic resonance imaging or hysteroscope provides more detailed information. The majority of patients have no symptoms and treatment is only indicated when there are symptoms that need to be corrected, particularly the spotting symptom. There are only a few of studies revealing that oral contraceptives could be used as a conservative treatment. Both thermo-ablation andcanalling are effective, but they should not be opted if a future pregnancy is expected. On the contrary, the laparoscopic or transvaginal repair of the defect is more promising. They both provide not only symptom correction but also improvement of the scar thickness.

关键词(KeyWords): 剖宫产;瘢痕缺陷;憩室;诊断;治疗
cesarean section;scar defect;niche;diagnosis;treatment

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作者(Author): 张多多;郎景和;朱兰;
ZHANG Duo-duo;LANG Jing-he;ZHU Lan;Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College;

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