宫腔镜下子宫中隔切除术后放置宫内节育器及应用激素补充治疗对术后妊娠结局的影响

Analysis on the Efficacy of Intrauterine Device and Hormone Replacement Therapy after the Transcervical Resection of Septa in Women with Septate Uterus

目的:探讨宫腔镜下子宫中隔切除术(TCRS)后放置宫内节育器(IUD)和(或)激素补充治疗(HRT)对中隔子宫患者妊娠和妊娠结局的影响。方法:对行B超监测下或腹腔镜下行TCRS并有生育要求和随访资料完整的113例患者的临床资料进行回顾性分析,对患者在术后采用不同的方法的妊娠情况进行比较,其中术后放置IUD及应用HRT治疗38例(IUD+HRT组),术后仅放置IUD 18例(单纯IUD组),术后仅应用HRT 22例(单纯HRT组)和仅单纯手术治疗35例(单纯手术组)。结果:113例患者的自然流产率由术前的88.75%下降至术后的20.39%,活产率由术前4.38%上升至术后73.79%,差异有统计学意义(χ2=1.243,P=0.000;χ2=1.398,P=0.000)。4组患者在妊娠率、自然流产率、活产率及妊娠距手术时间的比较,差异均无统计学意义(P>0.05);IUD+HRT组自然流产率(9.09%)低于单纯手术组患者(33.33%),但差异无统计学意义(χ2分割检验,P>0.009)。结论:TCRS治疗中隔子宫是一种简单、安全、有效的方法,但术后放置IUD和(或)HRT治疗对改善TCRS术后患者妊娠结局的疗效尚不确切。

Objective：To investgate the efficacy of intrauterine device（IUD） and hormone replacement therapy（HRT） after the transcervical resection of septa in women with septate uterus, Methods：113 patients with septate uterus and bearing requirement and a complete follow-up data were included, all of them re- ceived the treatment of TCRS：after surgery,38 patients received IUD ＋HRT（ IUD ＋HRT group） ,18 patients received IUD only（ IUD group） ,22 patients received HRT only （ HRT group）, and 35 patients received no postoperative treatment（ surgery group）, respectively. The clinical data of the patients were respectively ana- lyzed. Results：Miscarriage rates of patients with septate uterus were significantly decreased from 88.75% before the surgery to 20.39% after surgery（X2 = 1. 243, P = 0. 000）, and live birth rates were increased from 4.38% before the surgery to 73.79% after surgery （ X2 = 1. 398, P = 0. 000）, but no significant difference： was found in miscarriage rates,live birth rates or the duration of pregnancy from the operation among patients ~ with IUD ＋ HRT, IUD only, HRT only and no postoperative treatment （ P 〉 0. 05）. Although the miscarriage rate of patients with IUD and HRT（9.09%） was lower than that of patients without postoperative treatment （33. 33%） ,there was no significant difference between them. Conclusions ：TCRS is a safe, simple and ef- fective treatment for patients with uterine septum, but the efficacy of the postoperative treatment including IUD and HRT remains unclear.