宫腔镜子宫中隔矫治术后分娩结局分析  

Delivery after Transcervical Resection of the Septum

作　　者：石晓燕[1] 王素敏[1] 顾小燕[1] 杨大震[1] 花向东[1] 

机构地区：[1]南京医科大学附属南京妇幼保健院腔镜科,南京210004

出　　处：《中国微创外科杂志》2012年第11期1012-1014,共3页Chinese Journal of Minimally Invasive Surgery

摘　　要：目的探讨宫腔镜子宫中隔矫治术(transcervical resection of septum,TCRS)对分娩结局的影响。方法 2006年3月～2010年12月在我院进行子宫中隔宫腔镜矫治术143例,其中73例活产分娩(1例2次分娩),与同期2078例子宫结构正常并分娩的妇女进行比较,分析其剖宫产率、剖宫产原因、分娩期并发症及新生儿情况。结果 (1)TCRS术后组剖宫产、早产、臀位或横位、前置胎盘发生率分别为81.1%(60/74)、14.9%(11/74)、20.3%(15/74)、14.9%(11/74),明显高于对照组的42.3%(879/2078)、5.1%(107/2078)、5.5%(115/2078)、1.5%(32/2078)(χ2=43.694,11.208,24.803,58.163,P值均<0.01)。胎儿窘迫发生率TCRS术后组2.7%(2/74),对照组5.9%(122/2078),2组差异无显著性(P>0.05)。(2)TCRS术后组无指征剖宫产率为38.3%(23/60),明显高于对照组的17.4%(153/879)(χ2=16.151,P=0.000)。(3)TCRS术后组产后出血率21.6%(16/74),其中43.8%(7/16)需要输血,明显高于对照组的产后出血率13.4%(279/2078)(χ2=4.057,P=0.044)及输血治疗率6.8%(19/279)(χ2=21.302,P=0.000)。结论 TCRS术后分娩期新生儿存活率达到正常妇女水平,但是剖宫产率明显增高。为减少剖宫产率,不仅需要加强孕期及分娩期监护,预防分娩期并发症发生,更要加强患者充分试产的信心。Objective To discuss the influence of transcervical resection of septum （TCRS） on the outcomes of postoperative delivery. Methods Since March 2006 to December 2010, we performed TCRS on totally 143 patients （live birth in 73 cases including one patient who delivered twice）. During the same period, 2078 women with normal uterine structure delivered baby in our hospital, these women were set as a control group, and the rate and reasons of cesarean section, intrapartum complications, and the status of the newborn were compared between the TCRS group and the control. Results In the TCRS group, the rates of cesarean section, premature labor, breech or transverse position, and placenta previa were 81. 1% （60/74）, 14.9% （11/74） , 20.3% （15/74） , and 14.9% （11/74） , respectively; which were significantly higher than those in the control [42.3% （879/2078） , 5.1% （107/2078）, 5.5% （115/2078）, and 1.5% （32/2078）, χ2 =43.694, 11. 208, 24. 803, and 58. 163, all P 〈0.01]. No significant difference was detected in the rate of fetal distress between the two groups [ TCRS group vs. Control： 2.7% （2/74） vs. 5.9% （ 122/2078 ） , P 〉 0. 05 ]. TCRS group showed significantly higher rates of non-indicated cesarean section, postpartum hemorrhage and blood transfusion than the control [38..3% （23/60） vs. 17.4% （153/879） , χ2 = 16. 151, P =0. 000; 21.6% （16/74） and 43.8% （7/16） vs. 13.4% （279/2078） and 6.8% （19/279）, χ2 =4.057 and 21.302, P =0.044 and P =0.000]. Conclusions The rate of live birth after TCRS can reach the level in health woman, however the rate of cesarean section is increased after TCRS, therefore, we recommend intense pregnancy and intrapartum monitoring to avoid intrapartum complications, and to help patient gain confidence for vaginal delivery, so that to deceased the rate of Cesarean section.

关 键 词：生殖道畸形 子宫中隔 宫腔镜 妊娠结局 

分 类 号：R473.71[医药卫生—护理学]