中隔子宫不孕不育合并子宫内膜异位症的临床诊治

The clinical diagnosis and treatment of uterus septus infertility patients accompanying with endometriosis

目的:探讨中隔子宫不孕不育患者合并子宫内膜异位症的临床特征、诊断及治疗方法。方法:对2001年2月～2005年8月北京大学深圳医院住院治疗的24例中隔子宫不孕不育合并子宫内膜异位症患者的临床资料进行回顾性分析。结果:24例中隔子宫不孕不育患者全部合并子宫内膜异位症,平均年龄28.5岁,临床表现均为不孕不育,其中不孕不育16例,月经紊乱4例,无症状体检发现4例,全部患者经手术治疗(宫腔镜、腹腔镜联合手术)。手术证实完全中隔7例,不全中隔17例。子宫内膜异位症按(ASF-r)分期,均为Ⅰ～Ⅱ期,多处盆腔异位病灶8例,直肠窝异位病灶6例,子宫骶骨韧带异位病灶10例,所有患者术后均放置宫内节育器,雌激素治疗3～6个月,追踪随访妊娠10例,分娩5例。结论:中隔子宫不孕不育患者易合并子宫内膜异位症,应早期诊断、早期手术治疗,宫腔镜、腹腔镜联合手术治疗是治疗的最佳方法。术后雌激素治疗有利于子宫内膜的修复。但对盆腔子宫内膜异位病灶则不利,必要时需二次腹腔镜手术去除异位病灶,疗效满意。

Objective： To investigate the clinical characteristics, diagnosis and treatment of uterus septus infertility patients accompanying with endometriosis. Methods： Retrospective analysis the clinical material of 24 patients diagnosed of uterus septus infertility accompanying with endometriosis. These patients were all registered in Gynecologic ＆ Obstetrics Department of Shenzhen Hospital of Beijing University from February 2001 to August 2005. Results： 24 uterus septus infertility patients were all accompanied with endometriosis. Their mean age was 28.5 years old. Their clinical symptom all showed infertility, including 16 patients infertility, 4 patients menstrual irregularity, 4 patients no symptoms and signs-All patients were treated by surgery （hysteroscopy combined with laparoscopy） . The surgeries revealed 7 patients with complete uterus septus, 17 patients with incomplete uterus septus. The endometriosis were all remained stage Ⅰ- Ⅱ according to ASF-r staging. 8 patients showed multiple pelvic endometriosis foci, 6 patients showed endometriosis foci in pouch of Douglas, 10 patients showed endometriosis foci on uterosacral ligaments. All patients were put in IUD after surgery and were treated by estrogen for 3-6 months. By following-up, 10 patients were pregnant and 5 patients labored. Conclusion： The uterus septus infertility patients are easy to accompany with endometriosis and should be diagnosed and treated by surgery early. Hysteroscopy combined with laparoscopy is the optimal surgery choice. Treating by estrogen after surgery is beneficial to the recovery of endometrial, but is harmful to the pelvic endometriosis. If necessary, second laparoscopy should be done to destroy the endometriosis lesions and the treating result is satisfactory.