先天性子宫畸形的微创手术矫正分析

Analysis on the Treatment of Congenital Uterine Malformations with Minimally Invasive Surgery

目的 探讨先天性子宫畸形的微创手术的诊断与治疗价值.方法 收集2008年1月—2015年8月苏州大学附属第一医院行宫腔镜联合腹腔镜治疗的95 例子宫畸形患者的临床资料,并随访其术前术后的生殖结局.结果 (1)纵隔子宫在子宫畸形中发病率最高.(2)对先天性子宫畸形的诊断准确率从高到低依次为宫腔镜联合腹腔镜,二维超声,核磁共振,子宫输卵管造影(hysterosalpingography, HSG).(3)宫腔镜联合腹腔镜治疗先天性子宫畸形的完全矫正成功率为80.00%,部分矫正成功率为17.89%,失败率为2.11%.(4)随访95 例患者3 个月~7 年,术后妊娠成功率和活产率均明显高于术前,差异具有统计学意义(P<0.05).因流产就诊的患者妊娠成功率明显高于因不孕就诊的患者(P<0.05);(5)术后患者首次妊娠间隔时间平均为(8.67±5.69)个月,在术后最初的9 个月内患者的妊娠率增长最快.结论 先天性子宫畸形的金标准诊断方法是宫腔镜联合腹腔镜检查.对于先天性子宫畸形患者,微创手术治疗成功率高,安全有效,可降低自然流产率,提高活产率,明显改善其生殖结局.

Objective To discuss the diagnostic and therapeutic value of minimally invasive surgery for congenital uterine malformation.Methods We collected the clinical data of 95 patients with congenital uterine malformations treated with hysteroscopy combined with laparoscopy in the First Affiliated Hospital of Soochow University from January 2008 to August 2015 and followed up their reproductive outcome before and after operation.Results (1)The incidence of the septate uterus is the highest in the uterine dysplasia.(2)The diagnostic accuracy rate of congenital uterine malformations from high to low is hysteroscopy combined with laparoscopy, ultrasonography,magnetic resonance imaging,and hysterosalpingography.(3)The completely corrective success rate of hysteroscopy combined with laparoscopy in treating the congenital uterine malformations is 80.00%,the partial corrective success rate is 17.89% and the failure rate is 2.11%.(4)95 patients were followed up from 3 months to 7 years.The pregnancy success rate and the life birth rate were significantly higher after surgery (P <0.05).And the pregnancy success rate in patients of abortion was obviously higher than the patients of infertility (P <0.05).(5)The mean time interval between surgery and first pregnancy was (8.67±5.69)months.The pregnancy rate increased fastest in the first nine months after surgery.Conclusion The gold standard diagnostic methods for congenital uterine malformations is the hysteroscopy combined with laparoscopy.In women with congenital uterine malformations,the minimally surgery correction has a high success rate and is a safe and effective procedure with a decreasing spontaneous miscarriage rate and increasing live birth rate and significantly improved their pregnancy outcomes.