三维阴道超声检查和宫腔镜子宫中隔切除术在不孕症中的应用

Hysteroscopic Incision of Uterine Septum Assisted with Three-dimensional Ultrasonography for the Treatment of Infertility

目的:探讨三维阴道超声(3D-TVS)诊断后在门诊行宫腔镜下子宫中隔切除术在治疗中隔子宫不孕症患者中的应用价值。方法:选择2008年1月至2011年10月我院经3D-TVS初步诊断为中膈子宫且未合并盆腔病变的不孕患者71例,其中原发不孕24例,继发不孕47例。全部患者在门诊宫腔镜检查确诊中膈子宫后行子宫中隔切除术及双输卵管插管通液术。术后随访妊娠率及妊娠结局。结果:①经宫腔镜确诊,不完全中隔子宫53例,完全中隔子宫18例。3D-TVS诊断中隔子宫符合率为100.0%(71/71),明显高于二维经阴道超声(2D-TVS)诊断符合率73.2%(52/71)和输卵管造影(HSG)诊断符合率59.2%(42/71),差异有高度统计学意义(P<0.01)。②100%(71/71)患者1次子宫中隔切除术成功重建宫腔,无手术并发症。术后宫腔镜复查85.9%(61/71)宫腔形态正常,14.1%(10/71)宫腔轻度鞍型,输卵管插管术后通畅率达96.5%(137/142)。③原发不孕患者术后妊娠率70.8%(17/24)。继发不孕患者自然流产率由术前84.1%(58/69)下降为18.6%(8/43),足月妊娠率由术前2.9%(2/69)上升到74.4%(32/43),新生儿存活率由术前的5.8%(4/69)上升到74.4%(32/43),上述各指标手术前后比较,差异均有高度统计学意义(P<0.01)。结论:3D-TVS对中隔子宫的准确诊断是门诊无监护宫腔镜术的前提。3D-TVS诊断后在门诊行宫腔镜下子宫中隔切除术安全、可行,患者损伤小,是治疗未合并盆腔病变的中隔子宫不孕症患者的一种有效方法。

Objective：To explore the applicative value of hysteroscopic incision of uterine septum by scis sor for uterine septum with infertility after the diagnosis by throe-dimensional transvaginal ultrasonography （3D-TVS） in outpatient clinic. Methods：71 cases of uterine septum without pelvic diseases diagnosed by 3D-rvs in Guangdong provincial family planning research institute from January,2008 to October,2011 were divided into two groups：24 cases in primary infertile group,and 47 cases in secondary infertile group. All pa- tients underwent hysteroscopic incision of uterine septum by scissor and tubal catheterization in outpatient clinic,and postoperative pregnancy rate and outcome were followed up. Results：①Through 3D-TVS com- bined with hysteroscopy,53 cases were diagnosed with incomplete uterine septum, and 18 cases with com- plete uterine septum. The coincidence rate of 3D-TVS in the diagnosis of uterine septum was 100. 0% （71/71）, significantly higher than that of transvaginal ultrasonography （73. 2% ,52/71 ） and that of hystero- salpingography （59.2% ,42/71 ） （ P 〈 O. 01 ）. ②100. 0% （71/71） cases successfully reconstructed uterine cavity without operation complication after one operation. 85.9% （61/71） cases showed normal uterine cavi- ty,and 14. 1% （10/71） cases showed saddle-shaped uterine cavity. The fallopian patent rate was 96. 5% （ 137/142 ）. ③The postoperative pregnancy rate of primary infertile group was 70. 8% （17/24）. In secondaryinfertile group,the spontaneous abortion rate was lowered down to 18.6% （8/43）, which was 84. 1% （58/ 69） before operation,while the full-term pregnancy rate and live-birth rate were increased to 74. 4% （32/43） and 74.4% （32/43） respectively,which were 2. 9% （2/69） and 5. 8% （4/69） before operation. The above indexes were all significantly different before and after operation. Conclusions：The diagnosis accuracy of 3D-TVS for uterine septum is the premise of hysteroscopic incision of uterine septum without monitoring in outpatient clinic. With combination of 3D-TVS and hysteroscopic incision of uterine septum by scissor is safe, feasible, low-cost and micro-invasive, therefore it is an effective therapeutic method for infertility with uterine septum and without pelvic disease.