剖腹产后子宫壁的形成可以使患者将来容易发生产科并发症,例如裂开,子宫破裂,异位妊娠,和胎盘植入。这些并发症的显著发病率和死亡率以及增加的剖腹产率强调了预防的重要性。然而,术中预防产后生态位形成没有明确的指南.除了手术技术,富血小板血浆(PRP)和间充质干细胞(MSC)注射的新用途已显示出有希望的潜力,并且可能在子宫切开术封闭中具有应用价值.目的是检查当前有关最佳剖腹产程序的研究,以防止子宫壁龛形成和随后的产科并发症。使用PubMed和GoogleScholar进行了系统评价。初步搜索产生827个结果。纳入标准是人类,动物,和体外研究,同行评审的来源,以及与子宫生态位相关的结果。排除标准适用于术中和术前/术后近期与子宫肌层无关的结果和干预措施的文章。根据标准,共引用41篇文章。子宫生态位形成的病理生理学与宫颈组织切口有关,粘连形成,和差的近似。重要的危险因素是子宫切口低,晚期宫颈扩张,低站,腹膜不闭合,和膀胱皮瓣的产生。对子宫闭合没有达成共识,因为这可能取决于给定技术的手术熟练程度,但双层非锁定缝合线似乎可靠,以减少利基严重程度。最近的试验表明,术中注射PRP/MSC可能会降低利基发生率和严重程度,但是需要更多的研究。如果需要预防或最小化子宫生态位,最佳的剖腹产方案应避免子宫切口较低,根据外科医生的熟练程度选择子宫闭合技术(双层非锁定是可靠的),关闭腹膜,和子宫肌层注射PRP/MSC可能是一种有用的辅助干预措施,有待进一步的临床证据。
Formation of a uterine niche following a C-section can predispose the patient to future obstetric complications such as dehiscence, uterine rupture, ectopic pregnancy, and placenta accreta. The significant morbidity and mortality of these complications along with increasing C-section rates emphasizes the importance of prevention. However, there are no clear guidelines on intra-operative protocol to prevent postpartum niche formation. Besides surgical technique, the novel use of platelet-rich plasma (PRP) and mesenchymal stem cell (MSC) injections has demonstrated promising potential and may have applications in hysterotomy closures. The objective is to examine current research on optimal C-section procedures to prevent uterine niche formation and subsequent obstetric complications. A systematic
review was conducted using PubMed and Google Scholar. Initial searches yielded 827 results. Inclusion criteria were human, animal, and in-vitro studies, peer-reviewed sources, and outcomes pertinent to the uterine niche. Exclusion criteria applied to articles with outcomes unrelated to myometrium and interventions outside of the intra-operative and immediate pre-/post-operative period. Based on the criteria, 41 articles were cited. Pathophysiology of uterine niche formation was associated with incisions through cervical tissue, adhesion formation, and poor approximation. Significant risk factors were low uterine incisions, advanced cervical dilatation, low station, non-closure of the peritoneum, and creation of a bladder flap. There was no consensus on uterine closure as it likely depends on surgical proficiency with the given technique, but a double-layered non-locking suture appears reliable to reduce niche severity. Recent trials indicate that intra-operative PRP/MSC injections may decrease niche incidence and severity, but more research is needed. If prevention or minimization of uterine niche is desired, the optimal C-section protocol should avoid low uterine incisions, choose uterine closure technique based on the surgeon\'s proficiency (double-layered non-locking is reliable), and close the peritoneum, and myometrial injection of PRP/MSC may be a useful adjunct intervention pending further clinical evidence.