宫、腹腔镜联合诊治不孕症合并子宫中隔110例分析

Combined use of hysteroscopy and laparoscopy in the diagnosis and treatment of infertility with uterine septum: Analysis of 110 cases

目的探讨宫、腹腔镜诊治不孕症合并子宫中隔的临床价值，子宫中隔与不孕的关系。方法回顾分析我院1994年6月～2005年6月110例不孕症合并子宫中隔进行宫、腹腔镜联合手术的临床资料，其中原发不孕78例，继发不孕32例：分析不孕原因和宫、腹腔镜联合手术的诊治效果。结果110例中40．0％（44／110）为不明原因的不孕症。随访至2006年3月，82例列入统计，术后妊娠率为45．1％（37／82），原发不孕组术后妊娠率为46．6％（27／58），继发不孕组术后妊娠率为41．7％（10／24），2组比较无显著性差异（X^2=0．164，P=0．686）；不明原因不孕患者术后妊娠率为51．2％（22／43），有其他因素的不孕患者术后妊娠率为38．5％（15／39），二者比较无显著性差异（X^2=1．332，P=0．248）。不明原因不孕患者中，原发不孕患者术后妊娠率为56．7％（17／30），继发不孕患者术后妊娠率为38．5％（5／13）。结论不孕症合并子宫中隔应进行宫、腹腔镜联合手术，术后妊娠率提高，不孕症可能与子宫中隔畸形有一定的关系。

Objective To evaluate clinical effects of combined use of hysteroscopy and laparoscopy in the diagnosis and treatment of infertility with uterine septum, and to analyze the relationship between infertility and uterine septum. Methods Surgery using hysteroscopy combined with laparoscopy was performed in 110 patients with infertility accompanying uterine septum, including primary infertility in 78 patients and secondary infertility in 32 patients. The relative infertility factors and post-operative pregnancy prognoses were analyzed. Results Unexplained infertility accounted for 40% of patients （44/110）. As of March 2006, a total of 82 patients were successfully followed. The total post-operative pregnancy rate was 45.1% （37/82）, consisting of 46.6% in patients with primary infertility （27/58） and 41.7% in patients with secondary infertility （10/24）, without significant difference between the two groups （X2 = 0. 164, P = 0. 686 ）. The post-operative pregnancy rates in patients with unexplained infertility and etiologicallyclarified infertility were 51.2% （22/43） and 38.5 % （ 15/39）, respectively, without significant difference （X2 = 1. 332,P = 0. 248）. In patients with unexplained infertility, the post-operative pregnancy rate for primary infertility was 56.7% （17/30） and for secondary infertility, 38.5% （5/13）. Conclusions Combined use of hysteroscopy and laparoscopy for infertility with uterine septum can improve the post-operative pregnancy rate. The presence of uterine septum bears some relationship to the incidence of infertility.