基于病理变化创新治疗剖宫产切口瘢痕缺损的新术式

A new surgery mode to treat CSD based on pathological changes

目前剖宫产切口瘢痕缺损(cesarean scar defect,CSD)的手术效果不尽人意。郑州大学第一附属医院妇科基于CSD的病理变化,即:剖宫产切口局部肌层连续性中断及形成瘢痕缺损,瘢痕缺损部位内膜继发炎症反应、充血、异形血管、息肉形成等,采用宫腹腔镜联合手术,重建局部缺陷肌层,并处理继发病理变化,不切除任何本就缺陷的肌层,可显著改善异常子宫出血症状,创伤小、恢复快,且术后避孕时间短,推荐为治疗CSD的新的手术方式。

Currently,the surgical treatment for cesarean scar defect(CSD)is still unsatisfactory.In the department of Gynecology,the First Affiliated Hospital of Zhengzhou University,based on the pathological changes of CSD:diverticulum formation caused by myometrial discontinuity or defect and the secondary changes of the lining inner surface of diverticulum in the form of inflammatory reaction,congestion,atypical vessel formation and polyp,the laparoscopy-combined hysteroscopy surgical approach was adopted to correct not only the anatomical changes but also the secondary changes.In the surgery the diverticulum wasn’t cut open;therefore,the abnormal uterine bleeding symptom can be effectively relieved.Our operative strategy has the advantages of less trauma and faster recovery.In addition,it is more suitable for patients who desire to become pregnant soon after surgery.It’s recommended that this approach be used to treat CSD as a new standard surgery.