获得性子宫畸形的识别与分型的临床研究

A Study of Recognition and Clinical Type of Acquired Uterine Deformity.

探讨妊娠期手术和分娩方式对子宫复旧的影响所致的获得性子宫畸形及其特征、分型、诊断标准。收集1990年1月1日～1999年4月30日在我院行宫腔手术28377例,观察所有病例的子宫位置、大小和形态,既往妊娠、分娩和手术史,本次宫腔手术。其中329例同时测定子宫颈长度和子宫深度。获得性子宫畸形分为四型:宫颈宫腔粘连(Ⅰ型),子宫Ⅲ度后倾后屈(Ⅱ型),子宫前腹壁固定(Ⅲ型),颈管宫腔形态失常(Ⅳ型)。结果:筛查出获得性子宫畸形122例,其中发生于剖宫产后49例(1.28％),阴道分娩后31例(0.25％),流产后(未产妇)42例(0.35％)。Ⅰ型主要发生于流产后,Ⅱ型见于各种分娩、流产后,Ⅲ型和Ⅳ型多发生于剖宫产后。剖宫产后子宫颈长度和子宫深度明显大于阴道分娩和流产后(未产妇)(P<0.05)。通过122例畸形的归纳总结,提出了获得性子宫畸形的命名、分型和诊断标准,并剖析了形成的原因,对规范产科临床操作和妊娠期手术具有十分重要的价值。

Objective:To inquire into the acquired uterine deformitv and its characters types and diagnostic standards. The deformity are caused by the effect of operation during pregnancy and labour patterns on the recovery of uterus. Methods : 28 377 cases of uterine cavity operation were reeruited in our hospital during the time from 1,1,1990 to 4,30,1999 and recorded their ages,wterine positions sizes and features ,past pregnancies and labours,operation histories and current uterine cavity operations. 329 cases were observed of their cervix length and uterine depth. Postnatal uterine deformity is divided into 4 types: adhesion of cervix and uterine cavity ( Ⅰ ), Ⅲ degree of retroversion of uterus(Ⅱ ) ,anteflexion of uterus ( Ⅲ ) .deformity of cervix and wenme cavity(Ⅳ ). Results : 122 cases of postnatal uterine deformity were obtained 49 cases took place after caesarean section (1. 28%),31 cases after vaginal delivery (0. 25%), 42 cases after abortion (in unlabour women) (0. 35%). And the 1st type took place mainly after abortion,the second type in all kinds of labour and abortion, the 3rd type and the 4th type most after caesarean section. Patients'cervix length and uterine depth after caesarean section were obviously greater than that of vaginal delivery and abortion (in nullipara)(P<0. 05). Conclusion:By summing up the 122 cases of extra uterine deformity,in a scientific way the naming,types and diagnostic standard of postnatal uterine deformity and causes were. This mquirea inquiry is very valuable theoretically and practically to the standardization of obstetrical clinical operation and operations during pregnancy.