残留子宫纵隔的预测因素与妊娠结局的关系

Predictors of residual uterine septum and their relationship with pregnancy outcomes

目的探讨残留子宫纵隔与子宫纵隔长度和宽度的关系及生殖预后。方法采用回顾性研究,选择北京市平谷区医院及首都医科大学附属北京天坛医院2013年1月至2019年12月实施宫腔镜二次探查的139例子宫纵隔患者为主要对象,所有患者均实施经宫腔镜下子宫纵隔切除术(transcervical resection of septum,TCRS),术后随访2~6年,分析子宫纵隔残留的预测因素;子宫纵隔残留≤0.5 cm组及子宫纵隔残留>0.5 cm组的手术前后妊娠及产科结局。结果两组子宫纵隔的长度、宽度与残留子宫纵隔差异无统计学意义。子宫纵隔残留≤0.5 cm组及子宫纵隔残留>0.5 cm组的年龄、孕、产、流产、不孕、不孕时间比较,差异无统计学意义;术后妊娠时间、妊娠率、流产率、早产率、剖宫产率、术后并发症前置胎盘、产后出血比较,差异无统计学上意义;子宫纵隔残留≤0.5 cm组的足月产率高于子宫纵隔残留>0.5 cm组,差异有统计学意义(P<0.05)。两组术中、术后无一例近期并发症发生。结论所有行TCRS的患者术后2个月均需要二次宫腔镜探查,了解子宫纵隔残留情况;子宫纵隔残留>0.5 cm的子宫纵隔残留需要再次切除,改善妊娠结局。

Objective To explore the relationship between residual uterine septum and the length and width of uterine septum and its pregnancy outcome.Methods We collected 139 patients with uterine septum who underwent secondary hysteroscopy in Beijing Pinggu District Hospital and Tiantan Hospital affiliated to Capital Medical University from Jan.2013 to Dec.2019.All patients were treated by transcervical resection of septum(TCRS).They were followed up for 2-6 years.The predictive factors of residual septum were analyzed;Preoperative and postoperative pregnancy and obstetric outcomes in patients with septum residuals≤0.5 cm and septum residuals>0.5 cm were analyzed.Results There was no statistical significance in the length and width of the uterine septum and the residual septum.There were no statistically significant differences between the two groups of patients with septum residuals≤0.5 cm and septum residuals>0.5 cm in age,number of births,abortions,infertility,infertility time,and classification of uterine septum,pregnancy rate,miscarriage rate,preterm birth rate,cesarean section rate,postoperative complications,placenta previa,and postpartum hemorrhage were not statistically significant,and the difference in term birth rate was statistically significant.No recent complication occurred in the two groups during and after surgery(<0.05).Conclusions All patients with TCRS need second hysteroscopic examinations 2 months after operation to evaluate the condition of uterine cavity;more than 0.5 cm of residual septum should be removed again to improve pregnancy outcomes.