Gynecological and obstetrical outcomes after laparoscopic repair of a cesarean scar defect in a series of 38 women
Gynecological and obstetrical outcomes after laparoscopic repair of a cesarean scar defect in a series of 38 women
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DOI：
10.1016/j.fertnstert.2016.09.033
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发表时间：
2017-01-01
影响因子：
6.7
通讯作者：
Dolmans, Marie-Madeleine
中科院分区：
文献类型：
--
作者：
Donnez, Olivier;Donnez, Jacques;Dolmans, Marie-Madeleine
目的：评价妇科和产科的结果，以及剩余的子宫肌层厚度，在腹腔镜下修补剖宫产瘢痕。设计：观察性研究和前瞻性评价修复前后剩余的子宫肌层。设置：在大学医院的学术部门。患者：一系列的38个有症状的妇女剖宫产瘢痕缺陷和剩余的子宫肌层厚度小于3毫米，根据磁共振成像。干预措施：腹腔镜修复缺损。主要结局指标：剖宫产部位子宫肌层厚度增加，妇产科结局，切除后缺损的组织学分析。结果：子宫肌层平均厚度从术前1.43 +/- 0.7 mm显著增加至术后9.62 +/- 1.8 mm。除3名患者外，所有患者均无症状。在18名不孕妇女中，8名（44%）在妊娠38-39周时通过剖宫产怀孕并分娩健康婴儿。在所有38例病例中进行的组织学分析显示，8名妇女（21.1%）存在子宫内膜异位症。肌纤维密度显着低于相邻myometrium. Conclusions（S）：在有症状的妇女与残余子宫肌层厚度小于3毫米谁希望怀孕，腹腔镜修复可以被认为是一个合适的方法。((C)2016年美国生殖医学会（American Society for Reproductive Medicine）
Objective: To evaluate gynecological and obstetrical outcomes, as well as remaining myometrial thickness, after laparoscopic repair of a cesarean scar.Design: Observational study and prospective evaluation of the remaining myometrium before and after repair.Setting: Academic department in a university hospital.Patient(s): A series of 38 symptomatic women with cesarean scar defects and remaining myometrial thickness of less than 3 mm, according to magnetic resonance imaging. Intervention(s): Laparoscopic repair of the defect.Main Outcomes Measure(s): Increase in myometrial thickness at the site of cesarean section, gynecological and obstetrical outcomes, and histological analysis of the defect after excision.Result(s): The mean thickness of the myometrium increased significantly from 1.43 +/- 0.7 mm before surgery to 9.62 +/- 1.8 mm after surgery. All but three patients were free of symptoms. Among the 18 women with infertility, eight (44%) became pregnant and delivered healthy babies by cesarean section at 38-39 weeks of gestation. Histological analysis, performed in all 38 cases, revealed the presence of endometriosis in eight women (21.1%). Muscle fiber density was significantly lower compared with adjacent myometrium.Conclusion(s): In symptomatic women with residual myometrial thickness of less than 3 mm who wish to conceive, laparoscopic repair could be considered an appropriate approach. ((C) 2016 by American Society for Reproductive Medicine.)