剖宫产子宫切口瘢痕缺陷的宫腔镜手术治疗

剖宫产瘢痕憩室(CSD)是剖宫产术后远期并发症之一,CSD实际上是剖宫产子宫切口愈合不良所致,其形成的原因比较复杂。关于CSD有不少认识上的误区,对于没有症状的CSD一般不需要治疗,对于有症状的CSD如何治疗在认识上也比较混乱,如何选择合适的治疗方式不仅关系到医务人员对于CSD的认识也直接影响了CSD的治疗效果。有一种特殊类型的CSD是切口瘢痕下缘存在活瓣作用且由于活瓣作用而阻止了憩室内的经血顺利流出而出现症状(常见为经期延长),同时憩室内的异位子宫内膜也可能与宫腔内在位的内膜生长不同步也导致异常阴道流血,这种特殊的CSD学术界有个专业的名称即剖宫产子宫切口瘢痕缺陷(PCSD)。对于残余子宫壁肌层不是很薄的PCSD,可以采用宫腔镜手术切除活瓣并电凝破坏憩室内异位子宫内膜的治疗方法。而对于没有PCSD特点的CSD,宫腔镜手术的疗效较差,一般不采用宫腔镜手术治疗。文章将深入阐述PCSD的宫腔镜手术治疗的相关问题。

Hysteroscopic surgery treatment for cesarean scar diverticulum.

Cesarean scar diverticulum（CSD）is one of the long-term complications after cesarean section，and it is formed by poor healing of the uterine incision in cesarean section.The reasons for its formation are complicated.There are many misunderstandings about CSD.The treatment for CSD is not needed for the asymptomatic CSD generally，however，it varies when it comes to the symptomatic CSD.Therefore，how to choose the appropriate treatment for CSD is not only related to the understanding of gynecologists but also directly affects its therapeutic efficacy.There is a special type of CSD that has a flap at the lower edge of the incision scar that prevents the menstrual blood flowing out of the diverticulum due to the flap action，causing symptoms（usually prolonged menstruation）.The asynchronism of the growth of ectopic endometrium in the diverticulum and the eutopic endometrium in the uterine cavity may also lead to abnormal vaginal bleeding.Nowadays，academic community has a professional term for this particular type of CSDs，that is the previous cesarean scar defect（PCSD）.For the PCSDs whose residual muscular layer is thick enough，hysteroscopic resection of the valve located at the lower edge of the cesarean scar and coagulation of the ectopic endometrium in the diverticulum may achieve therapeutic efficacy.For the CSDs without the characteristics of PCSD，hysteroscopic surgery is less effective，and hysteroscopic surgery is generally not recommended.This article will elaborate on the issues related to hysteroscopic surgery for PCSD.