剖宫产术后切口憩室的诊疗现状及进展.docVIP

剖宫产术后切口憩室的诊疗现状及进展 余文华 王才智 （蚌埠医学院第一附属医院，蚌埠，233000） 【摘要】：剖宫产术后切口憩室（PCSD）是剖宫产术远期并发症之一，近年来剖宫产率居高不下，且随着对PCSD的认识提高，其发生率逐年攀升。PCSD临床上主要表现为阴道异常流血、痛经或下腹痛、再次妊娠致阴道大出血或子宫破裂可能等。临床诊断主要根据患者典型临床表现，排除内分泌疾病，同时结合辅助检查，如超声、磁共振(MRI)、子宫输卵管造影(HSG)、宫腔镜等，其中超声应用最广泛。PCSD治疗主要采用药物治疗和手术治疗，对于药物治疗无效的患者可采用手术治疗，包括经腹、阴式修补术、腹腔镜手术、宫腔镜手术或联合手术等，根据憩室类型选择不同方式，以达到良好治疗效果。 【关键词】剖宫产术；憩室；阴道流血；诊断；治疗 Cesarean section incision diverticulum status and progress of diagnosis and treatment YU Wen-hua,WANG Cai-zhi (The First Affiliated Hospital of Bengbu Medical College,Bengbu,Anhui 233000) Abstract:Cesarean section incision diverticulum (PCSD) is one of the cesarean section of long-term complications, in recent years the high cesarean section rate, and with improvement of understanding of PCSD, its incidence of rising year by year. PCSD mainly for clinical abnormal vaginal bleeding, menstrual cramps, or abdominal pain, vaginal bleeding or uterine rupture with pregnancy may again, and so on. Clinical diagnosis mainly according to patients with typical clinical manifestations, endocrine diseases, combined with auxiliary examination at the same time, such as ultrasound, MRI, HSG, hysteroscopy, including ultrasound applied most widely. PCSD mainly adopts drug therapy and surgery treatment, surgical treatment can be used in patients with drug treatment is invalid, including abdominal, Yin type repair, hysteroscopy surgery, laparoscopic surgery or joint operation, etc., choose different ways, depending on the type of diverticulum in order to achieve a good therapeutic effect. Key word: Cesarean section; Diverticulum; Vaginal bleeding; Diagnosis; treatment 剖宫产术是处理难产、严重的妊娠合并症或并发症、挽救母儿生命的重要手段，但由于孕妇要求的剖宫产的增加导致剖宫产率持续攀高，剖宫产术后近、远期并发症亦逐年增加，剖宫产术后子宫切口憩室（post-cesarean section scar diverticulum，PCSD）则是其远期并发症之一，PCSD又称剖宫产术后子宫瘢痕缺损或假腔等，是指剖宫产术后子宫下段切口愈合不良，导致经期延长、阴道出血淋漓不尽、性交后出血、下腹痛或经期腹痛、甚至不孕及疤痕处妊娠等后果，严重时危及生命。近年来PCSD发病率高达20%～60%，但其相关病 因机制尚不十分明确，治疗经验尚不足，暂无统一标准，本文就近年来PCS