宫腔镜手术对不同状态中隔子宫患者妊娠结局的影响

Effect of hysteroscopy on the pregnancy outcome of different conditions of patients with uterus septus

目的探讨宫腔镜手术对不同状态中隔子宫患者妊娠结局的影响。方法回顾性分析2013年1月~2014年6月在抚顺矿务局总医院妇产科治疗的77例行宫腔镜子宫中隔切除术且术后均妊娠的中隔子宫患者的临床资料,依据中隔基底宽度及中隔长度占宫腔深度的比来分组,观察比较术后活产率及自然流产率情况。结果不同子宫中隔长度患者手术出血量及手术时间比较差异无统计学意义(P>0.05);77例患者术后共妊娠77次,13次自然流产,64次活产。子宫中隔长度占宫腔深度1/3~2/3、>2/3组的活产率均明显低于子宫中隔长度占宫腔深度<1/3组,自然流产率明显高于子宫中隔长度占宫腔深度<1/3组,差异均有统计学意义(均P<0.05)。子宫中隔基底宽度≥1 cm组的活产率显著低于子宫中隔基底宽度<1 cm组,自然流产率显著高于子宫中隔基底宽度<1 cm组,差异均有统计学意义(均P<0.05)。结论子宫中隔基底宽度≥1 cm或子宫中隔长度不低于宫腔深度的1/3时可降低活产率,提高自然流产率。

Objective To investigate the effect of hysteroscopy on the pregnancy outcome of different conditions of pa- tients with uterus septus. Methods The clinical data of 77 cases of patients with uterus septus who took trans-cervical resection of septa and had pregnancy after operation treated in Department of Obstetrics and Gynecology, General Hos- pital of Fushun Mining Bureau from January 2013 to June 2014 was selected, the grouping was taken by the width of septa stratum basale and the ratio of the length of septa accounted for the depth of uterine cavity, the conditions of postoperative live birth rate and spontaneous abortion rate were observed and compared. Results There were no statistically significant differences of intraoperative blood loss and operation time among different length of septa （P 〉 0.05）. Total 77 cases had 77 times of pregnancy after operation, with 13 times of spontaneous abortion, 64 times of live birth. The live birth rates in the length of septa accounted for the depth of uterine cavity 1/3-2/3, 〉2/3 groups were all lower than that in the length of septa accounted for the depth of uterine cavity 〈1/3 group, while the spontaneous abortion rates were all higher than that in the length of septa accounted for the depth of uterine cavity 〈1/3 group, the differenees were all statistically significant （all P 〈 0.05）. The live birth rate in the width of septa stratum basale ≥ 1 cm group was lower than that in the width of septa stratum basale 〈1 cm group, while the spontaneous abortion rate was higher than that in the width of septa stratum basale 〈1 cm group, the differences were all statistically significant （all P 〈 0.05）. Conclusion The width of septa stratum basale ≥ 1 cm or the ratio of the length of septa accounted for the depth of uterine cavity ≥ 1/3 can decrease the live birth rate and increase the spontaneous abortion rate.