帝王切開瘢痕症候群に対して、子宮鏡観察下に腹腔内から穿刺した針先を指標にして瘢痕修復術を行った12例の検討

抄録

　In recent years, Cesarean Scar Disorder (CSDi) has been gaining attention due to its association with niche formation in the uterine incision post-cesarean section, leading to symptoms such as prolonged menstruation, abnormal bleeding, and infertility. Although various treatment approaches have been reported, a standardized procedure remains elusive, with limited reports on fertility improvement post-treatment and pregnancy outcomes. This study aimed to report the treatment outcomes of hysteroscopy-assisted cesarean scar repair surgery, including postoperative pregnancy results. Specifically, we focused on identifying the extent of scar tissue removal during abdominal scar repair surgery and evaluate the technique's effectiveness at our institution. All 12 cases studied were infertile cases, and patients who had failed to conceive after undergoing fertility treatment were considered for surgery.

　Procedures included hysteroscopy-assisted laparotomy in seven cases and laparoscopic surgery in five cases. Scar tissue removal was guided by hysteroscopic observation, with needle punctures marking the scar edges. Excision ensured adequate thickness of proximal and distal scar ends. Bilateral ends were sutured with absorbable material. Postoperatively, pregnancy was achieved in 58.3％ of cases, with six resulting in successful births and one experiencing recurrent miscarriages.

　No uterine ruptures or cesarean section complications were observed. The present study indicated that CSDi repair contributed to improve fertility and the post-operative pregnancy outcome was excellent. This technique, in which a needle is inserted from the abdominal cavity under hysteroscopic observation to identify and resect the scar site, was considered a safe and effective procedure.