剖宫产切口愈合不良的治疗方法

The Treatment of Previous Cesarean Scar Defect

剖宫产切口愈合不良亦称剖宫产切口憩室(previous cesarean scar defect,PCSD),是剖宫产术后远期并发症之一,可以引起经期延长、不孕、瘢痕妊娠等临床表现,发病率有增高趋势。常用的辅助检查为经阴道超声或盐水灌注宫腔声学造影。治疗方法以微创手术为主,包括宫腔镜、腹腔镜、阴式手术。宫腔镜是最微创的手术方式,通过电切憩室周边的瘢痕组织利于憩室内经血引流,同时电凝憩室内膜组织减少不规则出血,还可改善子宫内膜环境有利于妊娠,但因有电损伤及子宫穿孔等风险,适合于残余肌层大于2 mm的患者,术后妊娠者需要按照子宫破裂高危人群进行管理。而对于瘢痕憩室处子宫肌壁厚度<2 mm的患者建议采用腹腔镜手术或经阴道手术,通过切除瘢痕憩室后再次缝合,可有效改善症状。

Previous cesarean scar defect（PCSD） is one of the long-term complications after cesarean section,which can cause clinical manifestations of menstruation,infertility,cesarean scar pregnancy etc.The incidence rate of PCSD is increasing.The commonly used auxiliary examinations are transvaginal ultrasound and saline infusion sonohysterography.Minimally invasive surgerys are the main treatments,including hysteroscopy,laparoscopy and transvaginal surgery.Hysteroscopy is the most invasive surgery,it can remove the fibrotic scar tissue to facilitate menstrual blood drainage and perform fulguration of endometrial-like glands inside the scar to reduce irregular bleeding,it can also improve the endometrial environment conducive to pregnancy,but because of electrical injury and uterine perforation risk,it is suitable for patients whose residual muscle layer thickness is more than 2 mm,the postoperative pregnant women need to be treated as the high risk population of uterine rupture.As for the patients whose residual muscle layer thickness is less than 2 mm,laparoscopic surgery or vaginal surgery should be adopted to remove the scar diverticulum and suture it again,which can improve the symptoms effectively.