剖宫产瘢痕憩室及治疗方式选择

剖宫产瘢痕憩室（cesarean scar defect，CSD）是剖宫产术后常见的远期并发症之一，定义为愈合不良的瘢痕处内膜层向肌层外突起的局限性扩张和囊状突出。主要临床症状为不规则阴道出血、痛经、慢性盆腔痛、继发不孕等；现有治疗方式包括：药物治疗、宫腔镜憩室去除术及经阴道或腹腔镜下憩室修补术。针对不同情况的CSD患者如何选择最适合的治疗方式，尤其对于有生育要求的CSD患者，再次妊娠前是否手术修补憩室，修补的手术方式及修补后再次妊娠结局是否明显改善，是研究的重点问题。

Cesarean Scar Diverticulum and Treatment Options

Cesarean scar defect (CSD), a long-term complication of cesarean section, is defined as the localized dilation and cystic protrusion of the intimal layer to the extramuscular process in the scar with poor healing. The main manifestations of CSD are irregular vaginal bleeding, dysmenorrhea, chronic pelvic pain, secondary infertility and so on. Current treatments include drug therapy, hysteroscopic diverticulum removal and transvaginal/laparoscopic diverticulum repair. The most suitable treatment option should be personalized for CSD patients with different conditions, which is the emphasis of clinical research. Especially, for those CSD patients with fertility requirements, the focuses on treatment option are whether to undergo surgical repair before the next pregnancy, what kind of operation to be the most appropriate, and whether the outcome of pregnancy after surgical repair to be well improved.