Clinical and Histologic Evaluation of the Hysterotomy Site and Fetal Membranes after Open Fetal Surgery for Fetal Spina Bifida Repair
Clinical and Histologic Evaluation of the Hysterotomy Site and Fetal Membranes after Open Fetal Surgery for Fetal Spina Bifida Repair
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DOI：
10.1159/000488941
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发表时间：
2019-01-01
影响因子：
2.2
通讯作者：
Zimmermann, Roland
中科院分区：
文献类型：
--
作者：
Ochsenbein-Kolble, Nicole;Brandt, Simone;Zimmermann, Roland
导语：在与开放胎儿手术相关的风险中，子宫肌层和胎膜问题是令人头疼的问题，因为它们可能导致子宫裂开或胎膜早破，从而导致子宫破裂和/或早产。这项研究的目的是检查缝合和缝合子宫切开疤痕是否显示部分或完全愈合。方法：对36例剖宫产术中胎儿剖宫产术后子宫切开部位进行临床分析，将剖宫产分为完整、薄、部分或完全裂开3种类型，并对其中25例进行完全切除和组织学分析。组织学检查重点是子宫肌层和胎膜的创面愈合。结果：子宫肌层完整、薄、部分或完全裂开分别占33%、58%和9%。脊髓脊膜膨出修复和分娩之间的间隔与愈合过程无关。子宫肌层显示修复带(疤痕)与邻近的无生命肌层组织、纤维化和异物反应的炎症反应。完整的子宫肌层厚度小于1 mm者占56%。所有的胎膜都完全裂开；41%的胎膜是完全无生命的。结论：我们的研究提供了子宫肌层有大量变薄或裂开的疤痕形成的证据。胎膜不会自发愈合。为了防止再次怀孕时子宫破裂，我们建议在出生后将子宫切开部位完全切除。(C)2018年S.Karger AG，巴塞尔
Introduction: Among the risks associated with open fetal surgery, myometrium and fetal membrane issues are vexing problems since they may lead to uterine dehiscence or pre-term premature rupture of membranes resulting in uterine rupture or preterm birth or both. The aim of this study was to examine whether stapled and sutured hysterotomy scars demonstrate partial or complete healing. Methods: Hysterotomy sites after open fetal surgery were clinically evaluated in 36 women during Caesarean section, classified into the categories intact, thin, and partially or completely dehiscent, then completely excised and histologically analyzed in 25 cases. The histological examination focused on wound healing of myometrium and fetal membranes. Results: The myometrium was intact, thin, and partially or completely dehiscent in 33, 58, and 9%, respectively. The interval between myelomeningocele repair and delivery did not correlate with the healing process. The myometrium showed a reparative zone (scar) with adjacent avital myometrium tissue, fibrosis, and inflammation with foreign body reaction. The intact myometrium was below 1 mm thickness in 56%. All fetal membranes showed complete dehiscence; in 41% they were completely avital. Conclusion: Our study provides evidence that the myometrium shows scarring with substantial thinning or dehiscence. Fetal membranes do not heal spontaneously. In order to prevent uterine rupture in subsequent pregnancies, we recommend the hysterotomy site to be completely excised after birth. (c) 2018 S. Karger AG, Basel