剖宫产术后子宫瘢痕憩室患者宫腔积液的诊治进展

doi:10.12280/gjszjk.20220296

摘要/Abstract

摘要：

剖宫产是一种重要且常用的手术干预措施，但同时也增加了子宫瘢痕憩室（cesarean scar defect，CSD）的发生风险。CSD主要由剖宫产术后子宫切口愈合不良引起，临床上往往伴有宫腔积液，严重干扰宫腔微环境。目前对其治疗方式众多，但缺乏统一、有效、规范的治疗策略。综述剖宫产术后CSD患者宫腔积液的发生机制、对胚胎种植的影响及临床处理策略方面的研究进展。

关键词: 剖宫产术, 子宫, 瘢痕, 憩室, 宫腔积液, 机制, 治疗

Abstract:

Although cesarean section is an essential and common surgical intervention, it also increases the risk of cesarean scar defect (CSD), which is mainly caused by poor healing of the uterine incision. CSD is often accompanied by endometrial cavity fluid, which seriously interfere the embryos′ microenvironment. There are various therapies for CSD, while the unified, valid and standard therapeutic strategies are still inadequate. In this article, we reviewed the mechanism of endometrial cavity fluid in patients with CSD, as well as the impact on embryo implantation and the clinical strategies of treatment.

Key words: Cesarean section, Uterus, Cicatrix, Diverticulum, Endometrial cavity fluid, Mechanism, Therapy

曾中虹, 杨一华. 剖宫产术后子宫瘢痕憩室患者宫腔积液的诊治进展[J]. 国际生殖健康/计划生育, 2022, 41(6): 519-523.

ZENG Zhong-hong, YANG Yi-hua. Advances in Diagnosis and Treatment of Endometrial Cavity Fluid in Patients with Cesarean Scar Defect[J]. Journal of International Reproductive Health/Family Planning, 2022, 41(6): 519-523.

图/表 1

参考文献 36

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相关考量	生理性宫腔积液	病理性宫腔积液
成分	细胞因子、生长因子、离子、酶、蛋白质、葡萄糖和其他生物活性分子^[4]	炎性、血性和脓性分泌物^[5]
临床表现	一般无明显不适	伴有阴道异常分泌物、下腹疼痛、小腹坠胀感、发热等
积液的颜色	无色，清亮透明	黄色、血红色、黑褐色
积液的量	少量宫腔积液^[6]（宫腔线分离最大前后径<3.5 mm）	大量宫腔积液^[6]（宫腔线分离最大前后径≥3.5 mm）
出现时间	育龄期，多发生在排卵后或妊娠早期	绝经后，多与恶性疾病有关^[7]
持续时间	多为一过性^[6]	多为持续性^[6]
伴随疾病	多不伴随	多有伴随^[8]
与宫腔微环境的关系	改善宫腔微环境^[9]	干扰宫腔微环境^[10]
与妊娠结局的关系	一般不影响妊娠结局^[9]	导致不良妊娠结局^[10]

相关考量	生理性宫腔积液	病理性宫腔积液
成分	细胞因子、生长因子、离子、酶、蛋白质、葡萄糖和其他生物活性分子^[4]	炎性、血性和脓性分泌物^[5]
临床表现	一般无明显不适	伴有阴道异常分泌物、下腹疼痛、小腹坠胀感、发热等
积液的颜色	无色，清亮透明	黄色、血红色、黑褐色
积液的量	少量宫腔积液^[6]（宫腔线分离最大前后径<3.5 mm）	大量宫腔积液^[6]（宫腔线分离最大前后径≥3.5 mm）
出现时间	育龄期，多发生在排卵后或妊娠早期	绝经后，多与恶性疾病有关^[7]
持续时间	多为一过性^[6]	多为持续性^[6]
伴随疾病	多不伴随	多有伴随^[8]
与宫腔微环境的关系	改善宫腔微环境^[9]	干扰宫腔微环境^[10]
与妊娠结局的关系	一般不影响妊娠结局^[9]	导致不良妊娠结局^[10]