宫腔镜子宫纵隔切除术对合并自然流产子宫纵隔患者生殖预后的影响  

Effect of hysteroscopic transcervical resection of septa on prognosis of patients with uterine septum combined with spontaneous abortion

作　　者：冯雪 郝丽娟[1] 林奕[1] 雷莉[1] 孙文洁[1] 徐冬梅[1] 胡晓吟[1] Feng Xue;Hao Lijuan;Lin Yi;Lei Li;Sun Wenjie;Xu Dongmei;Hu Xiaoyin(Department of Reproductive Endocrinology,Chongqing Health Center for Women and Children,Chongqing 410013,China)

机构地区：[1]重庆市妇幼保健院生殖内分泌科,400013

出　　处：《中华生殖与避孕杂志》2019年第7期562-565,共4页Chinese Journal of Reproduction and Contraception

基　　金：重庆市基础研究与前沿探索项目(重庆市自然科学基金)(cstc2018jcyjAX0648)。

摘　　要：目的探讨自然流产合并子宫纵隔患者行宫腔镜子宫纵隔切除术(transcervical resection of septa,TCRS)后生殖预后.方法回顾性分析2016年1月-2017年12月期间于重庆市妇幼保健院就诊的88例有自然流产史的子宫纵隔患者的临床资料,根据孕产史分为复发性流产组(≥2次自然流产,40例)和偶发性流产组(1次自然流产,48例),比较两组患者TCRS术后治疗效果、妊娠结局和妊娠并发症.结果复发性流产组术后早期流产率由术前86.0%下降为13.3%,足月活产率由术前的2.8%上升到66.7%,差异均有统计学意义(P均<0.001).偶发性流产组术后早期流产率由术前81.1%下降为6.9%,足月活产率由术前的3.8%上升到75.9%,差异均有统计学意义(P均<0.001).复发性流产组宫腔粘连发生率(20.0%)高于偶发性流产组(4.2%,P=0.039),剖宫产率也更高(85.0%比54.5%,P=0.047),差异均有统计学意义.结论TCRS可明显改善有自然流产史的子宫纵隔患者的生殖预后,建议子宫纵隔患者在一次自然流产后尽早进行TCRS,可避免再次流产操作,减少宫腔粘连的发生及降低剖宫产率.Objective To analyze the effect of hysteroscopic transcervical resection of septa(TCRS)on prognosis of patients with uterine septum combined with spontaneous abortion.Methods From January 2016 to December 2017,88 patients with spontaneous abortion complicated with uterine septum were treated with TCRS in Chongqing Health Center for Women and Children.According to the history of pregnancy,the patients were divided into recurrent abortion group(≥2 times abortion,n=40)and incident abortion group(once abortion,n=48).Pregnancy outcomes between preoperative and postoperative were compared between the two groups.Then pregnancy outcomes and pregnancy complications were compared between the recurrent spontaneous abortion group and the sporadic abortion group.Results The early abortion rate in the recurrent spontaneous abortion group decreased from 86.0%to 13.3%after surgery,and the live birth rate increased from 2.8%to 66.7%postoperation(all P<0.001).The early abortion rate in the incident abortion group decreased from 81.1%to 6.9%after surgery,and the full-term live birth rate increased from 3.8%to 75.9%postoperation(all P<0.001).The incidence of intrauterine adhesions and cesarean section in the recurrent abortion group(20.0%,85.0%)was significantly higher than that in the incident abortion group(4.2%,54.5%)(P=0.039,P=0.047).Conclusion TCRS can significantly improve the pregnancy outcome of patients with spontaneous abortion.It is recommended that patients with uterine septum undergo transcervical resection of septum as soon as possible after the first spontaneous abortion,which can avoid re-abortion,and reduce the occurrence of intrauterine adhesions and the rate of cesarean section.

关 键 词：子宫纵隔 复发性流产 子宫纵隔切除术 妊娠结局 

分 类 号：R71[医药卫生—妇产科学]