吴珍珍;朱兰;

• 1:甘肃省妇幼保健院
• 2:中国医学科学院中国协和医科大学北京协和医院妇产科

摘要(Abstract)：

我国剖宫产率呈逐年上升趋势,剖宫产的远期并发症越来越引起人们的重视,剖宫产瘢痕缺陷(CSD)的概念被引入。目前尚无统一的定义。经阴道超声(TVUS)或(非妊娠妇女)生理盐水宫腔声学造影(SIS)检查,见子宫峡部前壁的充盈缺损,可诊断为CSD。本文主要通过文献回顾对CSD的概念、发病因素、临床表现及治疗做以全面概述,期望提高临床医生对CSD的识别能力,达到正确诊断、及时治疗的目的。

关键词(KeyWords)： 剖宫产瘢痕缺陷;诊断;治疗

Abstract:

Keywords:

基金项目(Foundation):

作者(Authors): 吴珍珍;朱兰;

DOI: 10.13283/j.cnki.xdfckjz.2013.12.017

参考文献(References)：

• [1]应豪,段涛.剖宫产后再次妊娠的流行病学调查[J].实用妇产科杂志,2004,20(5):260
• [2]Lumbiganon P,Laopaiboon M,Gulmezoglu AM,et al.Method of delivery and pregnancy outcomes in Asia:the WHO global survey on maternal and perinatal health 2007-08[J].Lancet,2010,375(9713):490-499
• [3]Fabres C,Aviles G,De La Jara C,et al.The cesarean delivery scar pouch:clinical implications and diagnostic correlation between transvaginal sonography and hysteroscopy[J].J Ultrasound Med,2003,22(7):695-702
• [4]Vikhareva Osser O,Valentin L.Risk factors for incomplete healing of the uterine incision after caesarean section[J].BJOG,2010,117(9):1119-1126
• [5]Hamar BD,Saber SB,Cackovic M,et al.Ultrasound evaluation of the uterine scar after cesarean delivery:a randomized controlled trial of one-and two-layer closure[J].Obstet Gyneco,2007,110(4):808-813
• [6]Hayakawa H,Itakura A,Mitsui T,et al.Methods for myometrium closure and other factors impacting effects on cesarean section scars of the uterine segment detected by the ultrasonography[J].Acta Obstet Gynecol Scand,2006,85(4):429-434
• [7]Yazicioglu F,Gokdogan A,Kelekci S,et al.Incomplete healing of the uterine incision after caesarean section:Is it preventable?[J]Eur J Obstet Gynecol Reprod Biol,2006,124(1):32-36
• [8]Ofili-Yebovi D,Ben-Nagi J,Sawyer E,et al.Deficient lower-segment cesarean section scars:prevalence and risk factors[J].Ultrasound Obstet Gynecol,2008,31(1):72-77
• [9]Thurmond AS,Harvey WJ,Smith SA.Cesarean section scar as a cause of abnormal vaginal bleeding:diagnosis by sonohysterography[J].J Ultrasound Med,1999,18(1):13-16;quiz 17-18
• [10]Wang CB,Chiu WW,Lee CY,et al.Cesarean scar defect:correlation between cesarean section number,defect size,clinical symptoms and uterine position[J].Ultrasound Obstet Gynecol,2009,34(1):85-89
• [11]Uppal T,Lanzarone V,Mongelli M.Sonographically detected caesarean section scar defects and menstrual irregularity[J].J Obstet Gynaecol,2011,31(5):413-416
• [12]Morris H.Surgical pathology of the lower uterine segment caesarean section scar:is the scar a source of clinical symptoms?[J].Int J Gynecol Pathol,1995,14(1):16-20
• [13]Borges LM,Scapinelli A,de Baptista Depes D,et al.Findings in patients with postmenstrual spotting with prior cesarean section[J].J Minim Invasive Gynecol,2010,17(3):361-364
• [14]Feng YL,Li MX,Liang XQ,et al.Hysteroscopic treatment of postcesarean scar defect[J].J Minim Invasive Gynecol,2012,19(4):498-502
• [15]Gubbini G,Centini G,Nascetti D,et al.Surgical hysteroscopic treatment of cesarean-induced isthmocele in restoring fertility:prospective study[J].J Minim Invasive Gynecol,2011,18(2):234-237
• [16]Garcia L,Isaacson K.Adenomyosis:review of the literature[J].J Minim Invasive Gynecol,2011,18(4):428-437
• [17]Diaz-Garcia C,Estelles JG,Escriva AM,et al.Scar abscess six years after cesarean section:Laparoscopic and hysteroscopic management[J].J Minim Invasive Gynecol,2009,16(6):785-788
• [18]Thubert T,Denoiseux C,Faivre E,et al.Combined conservative surgical and medical treatment of a uterocutaneous fistula[J].J Minim Invasive Gynecol,2012,19(2):244-247
• [19]Chen HY,Chen SJ,Hsieh FJ.Observation of cesarean section scar by transvaginal ultrasonography[J].Ultrasound Med Biol,1990,16(5):443-447
• [20]Fischer RJ.Symptomatic cesarean scar diverticulum:a case report[J].J Reprod Med,2006,51(9):742-744
• [21]Armstrong V,Hansen WF,Van Voorhis BJ,et al.Detection of cesarean scars by transvaginal ultrasound[J].Obstet Gynecol,2003,101(1):61-65
• [22]Osser OV,Jokubkiene L,Valentin L.Cesarean section scar defects:agreement between transvaginal sonographic findings with and without saline contrast enhancement[J].Ultrasound Obstet Gynecol,2010,35(1):75-83
• [23]Osser OV,Jokubkiene L,Valentin L.High prevalence of defects in cesarean section scars at transvaginal ultrasound examination[J].Ultrasound Obstet Gynecol,2009,34(1):90-97
• [24]Tower AM,Frishman GN.Cesarean scar defects:an underrecognized cause of abnormal uterine bleeding and other gynecologic complications[J].J Minim Invasive Gynecol,2013,20(5):562-572
• [25]Roberge S,Boutin A,Chaillet N,et al.Systematic review of cesarean scar assessment in the nonpregnant state:imaging techniques and uterine scar defect[J].Am J Perinatol,2012,29(6):465-471
• [26]Fabres C,Arriagada P,Fernandez C,et al.Surgical treatment and follow-up of women with intermenstrual bleeding due to cesarean section scar defect[J].J Minim Invasive Gynecol,2005,12(1):25-28
• [27]Chang Y,Tsai EM,Long CY,et al.Resectoscopic treatment combined with sonohysterographic evaluation of women with postmenstrual bleeding as a result of previous cesarean delivery scar defects[J].Am J Obstet Gynecol,2009,200(4):370 e1-4
• [28]陈玉清,常亚杰,姚书忠.阴式手术在子宫切口瘢痕憩室治疗中的应用[J].中华妇产科杂志,2012,47(8):626-628
• [29]Donnez O,Jadoul P,Squifflet J,et al.Laparoscopic repair of wide and deep uterine scar dehiscence after cesarean section[J].Fertil Steril,2008,89(4):974-980
• [30]Yalcinkaya TM,Akar ME,Kammire LD,et al.Robotic-assisted laparoscopic repair of symptomatic cesarean scar defect:a report of two cases[J].J Reprod Med.2011;56(5-6):265-70
• [31]Luo L,Niu G,Wang Q,et al.Vaginal repair of cesarean section scar diverticula[J].J Minim Invasive Gynecol,2012,19(4):454-458
• [32]Klemm P,Koehler C,Mangler M,et al.Laparoscopic and vaginal repair of uterine scar dehiscence following cesarean section as detected by ultrasound[J].J Perinat Med,2005,33(4):324-331