剖宫产子宫瘢痕缺损对采用辅助生殖技术孕妇妊娠结局的影响及对策  

Impact of cesarean scar defect on reproductive outcomes after assisted reproductive technology

作　　者：王玲[1] 赵晨含 章勤[1,3] WANG Ling;ZHAO Chenhan;ZHANG Qin(Department of TCM Gynecology,Hangzhou TCM Hospital Affiliated to Zhejiang Chinese Medical University,Hangzhou 310007,China;The First Clinical College,Zhejiang Chinese Medical University,Hangzhou 310053,China;Zhejiang Provincial Clinical Research Center for Obstetrics and Gynecology,Hangzhou 310016,China)

机构地区：[1]浙江中医药大学附属杭州市中医院中医妇科,浙江杭州310007 [2]浙江中医药大学第一临床医学院,浙江杭州310053 [3]浙江省妇产疾病临床医学研究中心,浙江杭州310016

出　　处：《浙江大学学报（医学版）》2024年第3期313-320,共8页Journal of Zhejiang University(Medical Sciences)

基　　金：浙江省中医药科技计划(20GZS20220221ZX012);浙江省中医药创新团队(2022SJCXTD);国家中医药管理局全国名老中医药专家传承工作室建设项目(国中医药人教函〔2022〕75号)。

摘　　要：近二十年中国的剖宫产率持续上升,导致继发性不孕的剖宫产瘢痕缺损(CSD)患者增加,需要通过辅助生殖技术(ART)解决再生育问题。CSD可显著降低ART活产率、临床妊娠率和胚胎植入率,这与患者子宫内膜容受性下降、瘢痕局部发生腺肌病及子宫内膜异位症、宫腔微环境紊乱、ART操作难度及妊娠并发症增加有关。除了使用促性腺激素释放激素类似物可能改善妊娠结局,宫腔镜手术、腹腔镜手术和经阴道手术是治疗CSD的有效方法,可提高妊娠率。本文通过文献回顾,分析CSD对采用ART孕妇妊娠结局的影响及相应的治疗方法,以期为CSD患者管理及改善ART妊娠结局提供新思路。In the last twenty years,the cesarean section rate has been rising in China,leading to an increased prevalence of cesarean scar defect(CSD)and secondary infertility.CSD decreases receptivity of endometrium,induces adenomyosis and endometriosis,disrupts uterine micro-environment and causes difficulties in embryo transplant operation as well as has further pregnancy complications.For women undergoing assisted reproductive technology(ART),CSD significantly reduces live birth rate,clinical pregnancy rate and embryo implantation rate.CSD can be effectively treated by hysteroscopic surgery,laparoscopic surgery and transvaginal surgery to increase the pregnancy rate.This article reviews the research progress on the impact of CSD on the reproductive outcomes of ART,the potential factors and related treatments,and provides a reference for the management of CSD patients undergoing ART.

关 键 词：剖宫产 剖宫产瘢痕缺损 辅助生殖技术 妊娠结局 综述 

分 类 号：R715[医药卫生—妇产科学]