剖宫产切口憩室及其相关临床问题

The Diagnosis and Treatment of Cesarean Scar Diverticulum

近年来剖宫产切口憩室(cesarean scar diverticulum,CSD)发病率逐渐增加,引起临床关注。CSD作为剖宫产术的一种远期并发症,临床上主要表现为经期延长、阴道出血淋漓不净,另可能引起下腹隐痛、不孕甚至发生再次妊娠晚期子宫破裂等。临床上诊断主要根据患者典型临床表现结合辅助检查,超声检查最为常用。磁共振成像(MRI)是最准确的辅助检查,宫腔镜下检查最为直观,另有子宫输卵管造影(HSG)等。目前治疗措施主要为激素保守治疗和手术治疗,手术包括经腹、经阴道手术、宫腔镜手术、腹腔镜术或联合手术。经腹手术已少用,宫腔镜治疗微创且直观,适用于MRI测量憩室距离子宫浆膜层>2 mm者,憩室处子宫肌壁厚度<2 mm者多采用腹腔镜或经阴道手术或联合手术。就目前临床上CSD及其具体相关临床问题进行综述。

Cesarean scar diverticulum（ CSD） is a late complication of cesarean section. More and more patients are suffered from CSD with symptoms such as prolonged menstruation,postmenstrual spotting,chronic pelvic pain,infertility and even uterine rupture in the late pregnancy. So doctors are gradually paying more attention to CSD because of its increasing incidence in recent years. Clinical diagnosis of CSD depends on its typical clinical manifestations and auxiliary examinations.Ultrasound is most commonly used. Magnetic resonance imaging（MRI） is the most accurate auxiliary examination. Others includes hysteroscopy and hysterosalpingography（HSG） etc. The current therapy for this disease is oral contraceptives（OCs） and surgeries,which include abdominal interventions,transvaginal repair,hysteroscopic niche resection,laparoscopic niche repair,or combined surgery of them. Among these, abdominal interventions are seldom used, hysteroscopic niche resection is the most minimally invasive and it′ s suitable for the patients whose diverticulum to serosal layer 〉2 mm under MRI measurement, that whose diverticulum to serosal layer〈 2 mm are usually choose the laparoscopic niche repair or transvaginal repair or combined surgery. This review is about CSD and its clinical treatment.