156例宫腔镜下子宫纵隔切除术后的生殖预后  

Reproductive prognosis of 156 cases of hysteroscopic transcervical resection of septum

作　　者：赵雪燕 李卫民 徐云[2] 赵辉[2] 李春霞[2] 冯力民[2] ZHAO Xueyan;LI Wei min;XU Yun;ZHAO hui;LI Chunxia;FENG Li min(Department of Obstetrics and Gynecology,Pinggu Hospital Beijing,Beijing 101200,China)

机构地区：[1]北京平谷区医院妇产科,101200 [2]首都医科大学附属北京天坛医院

出　　处：《中国妇产科临床杂志》2022年第1期38-41,共4页Chinese Journal of Clinical Obstetrics and Gynecology

摘　　要：目的探究和分析宫腔镜下子宫纵隔切除术(TCRS)的手术指征及生殖预后。方法采用回顾性研究方法,选择北京市平谷区医院及首都医科大学附属北京天坛医院2013年1月至2019年12月接收的156例纵隔子宫患者为主要对象,所有患者均实施宫腔镜下子宫纵隔切除术治疗,术后随访2~6年,分析患者术后妊娠及分娩结局。结果(1)25例有生育要求的患者行预防性切除子宫纵隔,术后22例(88.0%)妊娠,其中16例分娩(64.0%),6例流产(24.0%);(2)术中无1例发生子宫穿孔,出血及经尿道前列腺电切(TURP)综合征。术后无妊娠期子宫破裂发生。发生宫腔粘连5例(3.2%),均为轻微粘连;(3)不孕率、自然流产、稽留流产率分别由术前的21.9%、22.8%、29.8%降至8.4%、10.8%、7.2%,足月分娩率及活产率由术前的1.8%、2.6%升至66.3%、69.9%,术后妊娠率72.5%,手术前后比较差异有统计学意义(P<0.05)。结论对于诊断为子宫纵隔并且有生育要求的患者,建议进行预防性切除子宫纵隔;宫腔镜下子宫纵隔切除手术(TCRS)微创、安全、有效,能够明显改善其妊娠结局。Objective To analyze the prevention of complications and reproductive prognosis of transcervical resection of septum(TCRS).Methods 156 patients with septate uterus treated in Pinggu District Hospital and Tiantan Hospital affiliated to Capital Medical University were collected from January 2013 to December 2019.All of the patients were followed up for 2 to 6 years.Perioperative pregnancy outcomes and obstetric outcomes were analyzed.Results(1)Preventive excision of uterine septum were performed in 25 patients with fertility requirements.22 cases(88.0%)got pregnant after operation,in which 16 cases(64.0%)delivered and 6 cases(24.08%)miscarriage.(2)There was no uterine perforation,bleeding and transurethral resection of the prostate(TURP)syndrome occurred during the operation.No uterine rupture occurred after operation.5 cases(3.2%)had intrauterine adhesions,all slight adhesions.(3)The rate of infertility,spontaneous abortion,and missed abortion before surgery were 21.9%,22.8%,and 29.8%respectively,and all decreased to 8.4%,10.8%,and 7.2%after TCRS.The full-term delivery rate and live birth rate before surgery were 1.8%and 2.6%,increase to 66.3%and 69.9%after TCRS,with statistically significant difference(P<0.05).Conclusions Preventive excision of uterine septum is recommended for patients with fertility requirements.Oral estrogen and progesterone artificial cycle therapy are not needed to prevent intrauterine adhesions after TCRS.TCRS is minimally invasive,safe and effective,and can significantly improve the pregnancy outcome.

关 键 词：宫腔镜 子宫纵隔切除术 手术指征 手术中及术后并发症 妊娠结局 

分 类 号：R713.4[医药卫生—妇产科学]