宫腔镜下子宫纵隔切开术后妊娠结局分析

Pregnancy outcome after hysteroscopic transcervical incision of uterine septum

目的探讨宫腔镜下子宫纵隔切开术(TCIS)后妊娠结局。方法不全子宫纵隔患者193例行TCIS,分析术后妊娠结局。结果 193例患者无一例发生水中毒、穿孔、大出血或感染等并发症。其中,188例均行宫腔镜二次探查,未发现宫腔粘连及纵隔残余。193例患者术后随访时间12～60个月。154例患者术后1年内妊娠。176例患者妊娠184次,自然流产30次,其中早期自然流产24次,晚期自然流产6次;异位妊娠5次;无死胎死产。17例未孕患者中,原发不孕7例,继发不孕10例。176例患者分娩145次,其中早产19次,足月产126次。孕周26～42周,共有活产儿150个,新生儿体重(3263.33±669.51)g。结论 TCIS能够改善不全子宫纵隔患者的妊娠结局,建议术后应尽快妊娠,并加强患者孕期管理及产程监护。

Objective To observe the pregnancy outcomes after transcervical hysteroscopic incision of uterine septum.Methods Clinical data of 193 patients with incomplete uterine septum received transcervical incision of uterine septum were retrospectively analyzed.The postoperative pregnancy outcomes were observed.Results No complications such as perforation or bleeding occurred.No intrauterine adhesions and mediastinal remnants were found in 188 cases,who had second hysteroscopy after operation.The patients were followed up for 12 to 60 months.The pregnancy in one year occurred in 154 cases,of whom a total of 184 times of pregnancy occurred in 176 cases.The spontaneous abortion occurred in 30 cases including early spontaneous abortion occurred in 24 cases and later spontaneous abortion occurred in 6 cases.Ectopic pregnancy occurred in 5 cases.No stillbirth happened.Of 17 infertile patients,7 cases had primary infertility and 10 cases had secondary infertility.There were 145 deliveries in 176 patients,including 19 premature births and 126 term births.Gestational weeks were 26-42 weeks.There were 150 live births with neonatal weights of(3263.33±669.51)g.Conclusion Transcervical incision of uterine septum can effectively improve the pregnancy outcomes of patients with incomplete uterine septum.It is suggested that pregnancy should be carried out as soon as possible after operation and the management of pregnancy and the monitoring of labor process should be strengthened.