子宫中隔合并不育患者宫腔镜电切术后生育状况分析  

Fertility Analysis of Patients with Uterine Septum and Concomitant Infertility after Transcervical Resection of Uterine Septum

作　　者：陈玉清[1] 黄纯娴[2] 钟依平[1] 裴慧慧[1] 朱云晓[1] 姚书忠[1] 

机构地区：[1]中山大学附属第一医院妇产科,广州510080 [2]中山大学医学院,广州510080

出　　处：《中国微创外科杂志》2013年第11期995-998,共4页Chinese Journal of Minimally Invasive Surgery

基　　金：广东省科技计划项目(20120401);广州市科技计划项目(12A022061820);广东省大学生创新实验项目(1055812318)

摘　　要：目的 探讨子宫中隔合并不育患者宫腔镜矫形术后的生育状况.方法 2010年2月～2011年12月对58例因子宫中隔合并不孕或自然流产行宫腔镜下子宫中隔电切术.用针状电极完全划开中隔,直至中隔基底部位.如果宫颈管有中隔,则予保留.结果 58例手术均一次成功,未发生术中、后并发症.58例随访15 ～ 37个月,（22.4±3.9）月.完全子宫中隔妊娠率由术前29.4％（5/17）升至术后64.7％ （11/17）（Z=-2.031,P=0.042）,不完全子宫中隔妊娠率由术前34.1％（14/41）升至术后73.2％ （30/41）（Z=-3.522,P=0.000）;完全子宫中隔自然流产率由术前100.0％（5/5）降至术后9.1％ （1/11）（Z=-3.371,P=0.002）,不完全子宫中隔患者自然流产率由术前100％（14/14）降至术后3.3％ （1/30）（Z=-6.229,P=0.000）;完全子宫中隔患者的足月活产率由术前0％ （0/5）升至术后62.5％（5/8）（Z=-2.165,P=0.030）,不完全子宫中隔患者的足月活产率由术前14.3％（2/14）升至术后95.8％（23/24）（Z=-5.044,P=0.000）.结论 宫腔镜下子宫中隔矫形术有助于提高子宫中膈合并不孕或流产的不育患者妊娠率,降低自然流产率,增加足月活产率,改善患者生殖预后.宫腔镜下子宫中膈电切矫形术是一种有效、安全、简单的手术方式.Objective To investigate the reproductive outcome of patients with uterine septum and infertility treated by hysteroscopic resection of uterine septum.Methods A total of 58 patients with uterine septum and concomitant infertility or spontaneous abortion underwent hysteroscopic resection of uterine septum between February 2010 and December 2011 in our hospital.The septum was fully cut up to the basal area by needle electrode.If the cervix had a septum,the septum would be preserved.Results Hysteroscopic resection of septum was performed on 58 patients successfully without intra-or post-operative complications.The duration of post-operative follow-up ranged between 15 and 37 months,with an average of （22.4 ± 3.9） months.The pregnancy rate of patients with complete uterine septum increased from 29.4％ （5/17） to 64.7％ （11/17） （Z =-2.031,P =0.042）.The pregnancy rate of patients with partial uterine septum increased from 34.1％ （14/41） to 73.2％ （30/41） （Z =-3.522,P =0.000）.The spontaneous abortion rates of patients with complete and partial uterine septum decreased from 100.0％ （5/5） and 100％ （14/14） （pre-operation） to 9.1％ （1/11） and 3.3 ％ （1/30） （post-operation）,respectively （Z =-3.371,P =0.002 ; Z =-6.229,P =0.000）.The full-term live birth rates of patients with complete and partial uterine septum increased from 0％ （0/5）and 14.3％ （2/14） （pre-operation） to 62.5％ 62.5％ （5/8） and 95.8％ （23/24） （post-operation）,respectively （Z =-2.165,P =0.030 ; Z =-5.044,P =0.000）.Conclusions For patients with uterine septum and concomitant infertility or spontaneous abortion,hysteroscopic resection of septum can increase the pregnancy rate and full-term live birth rate,decrease spontaneous abortion rate,and improve patients＇ reproductive prognosis.Hysteroscopic resection of uterine septum is an effective,safe and simple procedure.

关 键 词：子宫中隔 宫腔镜 流产 活产 生育状况 

分 类 号：R711.1[医药卫生—妇产科学]