宫腔镜下子宫完全纵隔电切术93例患者的妊娠结局及影响因素  

Pregnancy Outcomes and Influencing Factors of 93 Patients Underwent Hyste-roscopic Resection of Complete Uterine Septum

作　　者：曹剑[1] 杨静[2] 顾小燕[1] 许锋[1] 王素敏[1] 杨大震[1] CAO Jian;YANG Jing;GU Xiaoyan(Department of Gynecology,Women's Hospital of Nanjing Medical University,Nanjing Maternity and Child Health Care Hospital,Nanjing Jiangsu 210004,China;Department of Gynecology,The First Affiliated Hospital of Nanjing Medical University,Nanjing Jiangsu 210029,China)

机构地区：[1]南京医科大学附属妇产医院南京市妇幼保健院妇科,江苏南京210004 [2]南京医科大学第一附属医院妇科,江苏南京210029

出　　处：《实用妇产科杂志》2020年第11期868-871,共4页Journal of Practical Obstetrics and Gynecology

摘　　要：目的:分析腹腔镜监护宫腔镜下子宫纵隔电切术治疗93例子宫完全纵隔患者的生殖预后情况及其影响因素。方法:回顾性分析2008年3月至2017年6月南京医科大学附属妇产医院收治的具有完整随访资料的93例子宫完全纵隔患者的临床资料,进行电话追踪及门诊随访妊娠情况,统计分析妊娠情况及影响术后妊娠的相关因素。结果:对93例患者的术后生育情况进行跟踪记录,随访12~24个月,随访中位数20个月。①术后76例(81.72%)获得妊娠,累计妊娠次数83次,其中流产累计24人次,活产累计59例;59例活产中,47例(79.66%)剖宫产,12例(20.34%)顺产。与手术前比,手术后妊娠人次和活产人次增加,人均妊娠次数和流产人次减少,差异有统计学意义(P<0.05)。②宫腔镜二次探查后1个月妊娠13例(17.11%),2个月妊娠14例(18.42%),半年内共计妊娠46例(60.53%),术后1年共计妊娠61例(80.26%)。③妊娠患者的年龄、阴道纵隔、宫腔粘连与未妊娠患者比较,差异无统计学意义(P>0.05);而无盆腔粘连、有流产史和输卵管通畅的患者妊娠率更高,差异有统计学意义(P<0.05)。Logistic回归进行多因素分析,盆腔粘连(OR 8.802,95%CI 6.035~10.635)、流产史(OR 5.053,95%CI 3.256~12.369)为术后妊娠的危险因素,输卵管畅通(OR 0.051,95%CI 0.016~0.436)为术后妊娠的保护因素。结论:腹腔镜监护宫腔镜下子宫纵隔切除术可以显著降低子宫完全纵隔患者的自然流产率,提高妊娠率和活产率,改善妊娠结局。盆腔粘连、流产史、输卵管是否畅通是影响子宫纵隔切除术后患者妊娠的独立危险因素。Objective:To analyze the reproductive prognosis and influencing factors of 93 patients with com-plete uterine septumby hysteroscopic resection under laparoscopic monitoring.Methods:93 patients with com-plete uterine septum admitted to the Women's Hospital of Nanjing Medical University from March 2008 to June 2017 were retrospectively analyzed.Through telephone and outpatient follow-up,statistical analysis of related fac-tors affecting postoperative pregnancy was conducted.Results:Postoperative fertility were followed up for 12-24 months(median follow-up:20 months).76 patients had 83 pregnancies after operations with 24 miscarriages.A-mong 59 live births,47 cesarean sections(79.66%)and 12 natural labour(20.34%)were performed.The number of pregnancies and live births increased,and the number of pregnancies per capita and abortions decreased com-pared with pre-operations(P<0.05).13 patients(17.11%)got pregnant within 1 month after surgeries,wihle 14 pregnancies(18.42%)within 2 months,46 pregnancies(60.53%)within 6 months,and 61(80.26%)within 1 year.Age,vaginal mediastinum and intrauterine adhesion were not statistically related to infertility(P>0.05).The pregnancy rate was higher in patients without pelvic adhesion,history of miscarriage and unobstructed fallopian tube(P<0.05).Logistic regression showed that pelvic adhesions(OR 8.802,95%CI 6.035-10.635)and abor-tion history(OR 5.053,95%CI 3.256-12.369)were risk factors for postoperative pregnancy,and unobstuctedfal-lopian tubes(OR 0.051,95%CI 0.016-0.436)was a protective factor.Conclusions:Laparoscopic monitoring and hysteroscopic mediastinal resection can significantly reduce spontaneous abortion rate,increase pregnancy rate and live birth rate,and improve pregnancy outcome.Pelvic adhesions,history of miscarriage,and unobstruct-ed fallopian tubes are independent risk factors.

关 键 词：子宫完全纵隔 子宫纵隔电切术 妊娠结局 

分 类 号：R713.4[医药卫生—妇产科学]