宫腔镜技术诊治流产后宫腔妊娠残留伴子宫纵隔71例临床分析

Diagnosis and Treatment of 71 Cases of Abortive Remnants Combined with Uterine Septum Using Hysteroscopy

目的:探讨宫腔镜技术在流产后宫腔残留伴有子宫纵隔患者的诊治中的临床意义。方法:分析2006年1月—2012年1月在复旦大学妇产科医院确诊为流产后宫腔残留伴有子宫纵隔的71例患者的临床资料,71例均采用宫腔镜下子宫纵隔切开加残留灶去除术诊治。观察并记录术中出血情况、生命体征,监测术后出血情况及血人绒毛膜促性腺激素(β-human chorionic gonadotropin,β-hCG)水平,随访妊娠结局。结果:71例患者平均手术时间(33.8±3.1)min,术中出血量(15.2±2.8)mL。所有患者均无并发症,术后阴道流血时间(4.3±0.5)d,住院时间(6.5±1.7)d,术后24 h内β-hCG下降大于50%患者69例(97.2%)。术后随访(28.5±3.3)个月,失访7例;足月产57例(80.3%),早产3例(4.2%),复发性流产4例(5.6%)。结论:采用宫腔镜技术治疗流产后宫腔残留伴有子宫纵隔患者创伤小,术后恢复好,有利于改善妊娠结局。

Objective：To investigate the value of hysteroscopy in the diagnosis and treatment of abortive remnants combined with uterine septum. Methods：From January 2006 to January 2012, 71 cases of abortive remnants combined with uterine septum Treated in Obstetrics and Gynecology Hospital of Fudan University underwent transcervical incision of septa and resection of remnants under hysteroscope. The vital signs, the blood loss during operation, the decline of blood β-hCG were monitored, the pregnancy outcome were followed. Results： The mean operation time was （33. 8 ± 3. 1） min the mean blood loss was （15.2 ± 2.8）mL. All cases had no operative complication. The mean time of bleeding after the surgery was （4.3 ± 0.5）d. The mean length of hospital stay was （6.5 ± 1.7）d, In 69 cases（97.2%） blood β-hCG of decreased by more than 50% within 24 hours after the surgery. The mean follow-up time was （28. 5 ± 3.3）months, and 7 cases were lost to follow-up; 57 cases （80.3%） had term delivery, 3 cases（4. 2%） had premature delivery, 4 cases（5.6%） ahd recurrent spontaneous abortion. Conclusions： Application of hysteroscopy in patients with abortive remnants combined with uterine septum can improre the future chance of pregnancy.