子宫纵隔术后不同处理方案对生殖结局的影响分析  

Analysis on the effects of different treatment methods after transcervical resection of septa on reproductive outcome

作　　者：蔺茹[1] 何文华[1] 脱淑梅[1] 王晓黎[1] 李怡林[1] 白岩[1] LIN Ru;HE Wen-Hua;TUO Shu-Mei(Endoscope Center,Gansu Provincial Maternal and Child Health Care Hospital,Lanzhou,Gansu 730050,China)

机构地区：[1]甘肃省妇幼保健院内镜中心,甘肃兰州730050

出　　处：《中国妇幼保健》2019年第1期135-138,共4页Maternal and Child Health Care of China

基　　金：甘肃省卫生行业科研计划项目(GSWSKY-2015-24)

摘　　要：目的评估不孕症或不良孕产史妇女子宫纵隔电切术(TCRS)术后给予不同处理方案后的生殖结局,为TCRS术后良好生殖结局的处理方案提供依据。方法采取巢式病例对照研究方法,选取因不孕症或不良孕产史行TCRS术并有生育要求和随访资料完整的108例患者,分别对其术后采用3种不同的处理方案分组,第1组35例为交替人工周期+IUD;第2组37例仅行交替人工周期,术后不放置IUD;第3组36例为持续人工周期,术后不放置IUD。结果 108例患者术后不良孕产史发生率20. 4%较术前59. 3%明显下降,活产率(45. 4%)得以提高; 3组患者的妊娠率、自然流产率、活产率、早产率、足月产率比较,差异均无统计学意义(均P>0. 05);术后宫腔粘连的发生率放置IUD组高于未放置IUD的两组,但3组比较差异无统计学意义(P>0. 05)。结论 TCRS治疗子宫纵隔是一种简便、有效的手术方法,术后使用不同雌孕激素人工周期方案及宫内放环与否三者术后宫腔粘连发生率、生殖结局比较差异无统计学意义(P>0. 05),但宫腔粘连的发生率放置IUD组高于未放置IUD的两组。Objective To evaluate the reproductive outcome of different treatment methods after transcervical resection of septa(TCRS) in women with infertility or adverse pregnancy history,provide a basis for good reproductive outcome after TCRS.Methods A nested case-control study was conducted,108 patients with birth requirement and intact follow-up data undergoing TCRS due to infertility or adverse pregnancy history were selected and divided into three groups according to postoperative treatment methods:the first group(35 patients,alternate artificial cycle and IUD),the second group(37 patients,alternate artificial cycle),and the third group(36 patients,continuous artificial cycle).Results The incidence rate of postoperative adverse pregnancy history was 20.4%,which was statistically significantly lower than that before operation,the survival rate after operation was 45.4%.There was no statistically significant difference in pregnancy rate,spontaneous abortion rate,live birth rate,premature birth rate,and full-term delivery rate among the three groups(P >0.05).The incidence rate of postoperative intrauterine adhesion in the first group was higher than those in the other three groups,but there was no statistically significant difference(P >0.05).Conclusion TCRS is a simple and effective treatment for patients with uterine septum.There is no statistically significant difference in the incidence rate of postoperative intrauterine adhesion and reproductive outcome among the patients treated by different estrogen and progestogen artificial cycle methods,using IUD or not.The incidence rate of postoperative intrauterine adhesion patients using IUD is higher than that in patients not using IUD.

关 键 词：子宫纵隔 妊娠结局 宫腔镜下子宫纵隔电切术 宫内节育环 

分 类 号：R713[医药卫生—妇产科学]