复发性流产患者子宫纵隔电切术后的生殖结局

Analysis of the reproductive outcomes after hysteroscopic transcervical resection of septum in patients with recurrent spontaneous abortion

目的 探讨子宫纵隔所致的早期复发性流产(ERSA)患者宫腔镜子宫纵隔电切术(TCRS)后的生殖结局,并分析术后1年继发性不孕症的风险因素。方法 选取29例子宫纵隔合并ERSA(≥2次)患者,根据TCRS后1年是否妊娠分为不孕组与妊娠组,比较两组临床资料;观察并比较术后妊娠分娩者与同期2955例正常妊娠初产妇(为正常对照组)的产科结局。结果 29例患者均接受随访,23例患者妊娠,妊娠率为79.3%,6例患者术后1年未孕。术后累积妊娠25次,自然流产率8.0%,活产率88.0%,手术前后相比,异位妊娠率及死胎率比较,差异均无统计学意义(P>0.05),自然流产率明显下降,活产率显著升高,差异均具有统计学意义(P<0.01)。妊娠组年龄明显低于不孕组,差异具有统计学意义(P<0.01)。Logistic回归分析表示,年龄是导致术后继发性不孕症的独立危险因素(OR=1.518,95%CI:1.076,2.142,P=0.017<0.05)。术后妊娠分娩组与同期正常对照组相比,剖宫产率及胎盘粘连率均显著升高(P<0.05)。结论 TRCS能有效改善子宫纵隔ERSA患者的妊娠结局,年龄是术后继发性不孕症的重要独立危险因素。

Objective To investigate the reproductive outcomes of transcervical resection of septum(TCRS) in patients with early recurrent spontaneous abortion(ERSA) and illuminate the risk factors of secondary infertility one year after surgery.Methods 29 patients with mediastinal ERSA(≥2 times) were selected and divided into infertility group and pregnancy group according to whether there was pregnancy one year after TCRS.The clinical data of the two groups were compared.The obstetric outcomes of postoperative pregnant women and 2955 normal pregnant primiparas(normal control group) were observed and compared.Results All 29 patients were followed up,23 patients were pregnant,the pregnancy rate was 79.3%,6 patients were not pregnant one year after operation.There were 25 cumulative pregnancies after operation,and the spontaneous abortion rate was 8.0% and the live birth rate was 88.0%.There was no significant difference in the ectopic pregnancy rate and stillbirth rate between before and after operation(P>0.05).The spontaneous abortion rate decreased significantly,and the live birth rate increased significantly(P<0.01).The age of pregnancy group was significantly lower than that of infertility group(P<0.01).Logistic regression analysis showed that age was an independent risk factor for postoperative secondary infertility(OR=1.518,95%CI:1.076,2.142,P=0.017<0.05).Compared with the normal control group,the cesarean section rate and placental adhesion rate in the postoperative pregnancy and delivery group were significantly increased(P<0.05).Conclusion TRCS for the uterine septum can effectively improve the pregnancy outcomes of patients with ERSA and age was a significant and independent risk factor for post-operative secondary infertility.