超声引导和腹腔镜监视下子宫中隔切除术的手术疗效比较

Ultrasonography Versus Laparoscopy in Transcervical Resection of Septa: A Randomized Clinical Trial

目的 比较在经宫颈子宫中隔切除术（TCRS）术中超声和腹腔镜两种监护方法的手术效果。方法 选择2010年1月至2013年8月子宫中隔住院患者126例,将其随机分为超声组（70例）和腹腔镜组（56例）,在TCRS术中分别用超声和腹腔镜监护,比较其手术情况,并随访6-24个月,比较术后近远期并发症及妊娠结局。结果 两组患者均能顺利完成手术。但超声组手术时间、首次下床时间、术后24h NRS值、术后住院日、术后中隔残留发生率均明显少于腹腔镜组,差异有统计学意义（P〈0.05）;余手术近远期并发症发生率及妊娠结局均无明显差异（P〉0.05）。结论 超声引导和腹腔镜监视下TCRS均是安全、有效的治疗子宫中隔的方法,但超声引导更简便、无创、经济、准确,对于术前检查盆腔无异常病变子宫中隔患者,我们更倾向于选择超声引导下TCRS。

Objective To compare the effects ofultrasonography with laparoscopy on transcervical resection of septa （TCRS）. Methods The study included 126 patients with uterine septum at the present hospital between January 2010 and August 2013 that were randomly divided into two groups. Seventy patients had TCRS monitored by ultrasound （ultrasound group） while 56 patients were monitored by laparoscope （laparoscope group）. Both groups were followed up for six to 24 months. The intraoperative status, short-term and long-term complications after operation, and pregnancy outcome of two groups were compared. Results The operations of both groups were successfully completed. The operating time, the first time to get out of bed, postoperative 24hNRS （numeric rating scale） values, postoperative hospital stay, and the incidence of postoperative septum residue of ultrasound group were significantly less than laparoseope group （P〈0.05）. No statistical differences were observed in intraoperative complications and pregnancy ratio between the two groups. Conclusion Both ultrasound and laparoscope monitored TCRS were safe and effective in the treatment of uterine septum. Ultrasound monitored TCRS was more simple, economical, accurate, and non-invasive. For patients without abnormal lesions in pelvic cavity, the present authors tend to choose the ultrasound monitored TCRS.