宫腔镜子宫纵隔切除术对完全性纵隔子宫妊娠结局的影响

The Impact of Transcervical Resection of Septum Via Hysteroscopy on Pregnancy Outcome in Patients With Complete Septate Uterus

目的探讨宫腔镜子宫纵隔切除术对完全纵隔子宫患者妊娠结局的影响。方法回顾性分析我院92例完全子宫纵隔患者行宫腔镜子宫纵隔切除术后的临床资料,并随访妊娠结局。结果自然流产率、围产儿死亡率分别由术前的68.23%、75.00%下降至术后的10.52%、0.00%,差异有统计学意义(P<0.001)。术后妊娠率、足月产率、活产率,分别由术前的57.60%、1.17%、3.52%上升至88.04%、82.10%、84.21%,差异均有统计学意义(P<0.001)。切除宫颈中隔组(n=18)与保留宫颈中隔组(n=20)术后的足月产率分别是81.81%(18/22)和80.00%(12/15),早产率分别是0%(0/22)和0%(0/15),宫颈环扎数/分娩数,分别是5.55%(1/18)和8.33%(1/12),差异均无统计学意义(P>0.05)。结论宫腔镜手术治疗完全子宫纵隔能够提高患者的妊娠率、足月产率、活产率,降低自然流产率、围产儿死亡率,改善患者的生殖预后。与保留宫颈中隔比较,切除宫颈中隔不影响患者术后足月产率、早产率、宫颈环扎率,但可降低术后剖宫产率。

Objective To evaluated the impact of transcervical resection of septum （TCRS） via hysteroscopy on pregnancy outcome in patients with complete septate uterus. Methods A retrospective study involved 92 patients with complete septate uterus underwent TCRS was conducted. Their reproductive outcome was followed and analyzed. Results After TCRS, the spontaneous abortion rate declined from 68.23% to 10.52%, perinatal mortality declined from 75.00% to 0.00%. There were highly significant diferences （P 〈 0.001）. Pregnancy rate rose to 88.04% from 57.60%,full-term delivery rate rose to 82.10% from 1.17%, and live birth rate rose to 84.21% from 3.52%, there were statistically significant differences between postoperative and postoperative （P 〈 0.001）. T;aere were no statistically significant differences （P 〉 0.05） ia the full-term delivery rate[81.81%（18/22）vs. 80.00%（12/15）], preterm delivery rate[O%（O/22）vs. 0%（0/15）] and the cervical cerclage rate [5.55%（1/18） vs. 8.33%（1/12）] between patients treated with removal oftbe cervical septum （n=18） or keep the cervical septum （n=20）. Conclusion TCRS can obviously improve the pregnancy outcomes, including pregnancy rate, full-term delivery rate, live birth rate and reproductive prognosis, reduce natural abortion rate and perinatal mortality rate. Comparing to keep the cervical septum, removal of the cervical septum doesn＇t affect full-term delivery rate, preterm delivery rate or cervical cerclage rate, but it can reduce cesarean rate.