宫腔镜下纵隔子宫电切术治疗不同类型纵隔子宫的对比研究

Comparative Analysis of Hysteroscopic Metroplasty in the Treatment of Different Sizes of Uterine Septum

目的:评估不同类型纵隔子宫经宫腔镜纵隔子宫电切术后的生殖结局,探讨经宫腔镜下纵隔子宫电切术后患者的生育力是否与纵隔子宫的类型有关。方法:回顾性分析2012年7月至2020年7月广州医科大学附属第三医院因纵隔子宫经宫腔镜下纵隔子宫电切术患者共179例,分为A组(完全纵隔子宫组)56例,B组(不全纵隔子宫组)123例,比较两组患者经宫腔镜下纵隔子宫电切术术后治疗效果、妊娠结局和术后并发症。结果:术前A组56例患者有4例活产(6.90%),在经宫腔镜下纵隔子宫电切术后1~5年随访期内,活产率升高至66.18%,早期流产率由术前的82.76%下降至29.41%,差异均有统计学意义(P<0.001)。B组123例患者术前有13例活产(8.44%),术后活产率升高至71.63%,早期流产率由78.57%下降至21.99%,差异均有统计学意义(P<0.001)。两组患者经宫腔镜纵膈子宫电切术后不孕率、早期及晚期流产率、异位妊娠率、活产率、早产率、剖宫产率比较差异无统计学意义(P>0.05)。两组患者手术时间、术中出血量、术后并发症差异均无统计学意义(P>0.05)。结论:宫腔镜下纵隔子宫电切术可改善不同类型纵隔子宫患者的生殖结局,提高活产率,降低早期流产率,对于宫腔镜下纵隔子宫电切术术后生育力提高与纵隔子宫的类型无关,不同类型纵隔子宫术后并发症无明显差异。宫腔镜下纵隔子宫电切术是一种安全、可行的手术方式,建议对于有强烈生育要求的纵隔子宫患者可考虑经宫腔镜下纵隔子宫电切术切除纵隔后试孕。

Objective:Different sizes of uterine septum may have a clinical relevance in reproductiveperformance after surgery.This study aimed to assess if the fecundity of women after surgical correction of the uterine septum isassociated with septum size.Methods:July 2012 to July 2020,179 cases of different sizes of uterine septum were enrolled,they were divided into the group A(n=56)and the group B(n=123).The therapeutic effects,pregnancy outcome and postoperative complications of the two groups was compared.Results:In our study,4 of 56 patients in group A were pregnant before surgery.During the follow-up period of 1 to 5 years after hysteroscopic mediastinal hysterectomy,the live birth rate increased to 66.18%,and the early abortion rate decreased from 82.76%to 29.41%,with statistical significance(P<0.001).Among the 123 patients in group B,there were 13 live births before surgery(8.44%),the live birth rate increased to 71.63%after surgery,and the early abortion rate decreased from 78.57%to 21.99%,with statistical significance(P<0.001).No significant differences in infertility rate,early abortion rate,late abortion rate,ectopic pregnancy rate,live birth rate,premature birth rate and cesarean section rate were found between the two groups.The operating time,blood loss during surgery,and postoperative complication rate in the two groups were not statistically significant(P>0.05).The live birth,neonatal outcomes and mode of delivery were not statistically significantly different between the two groups(P>0.05).Conclusions:Hysteroscopic metroplasty resection can improve the reproductive outcome of patients with different sizes ofuterine septum in the reproductive age and increase the pregnancy rate.The improvement of fertility after hysteroscopic hysterectomy was independent of the type of mediastinal uterus,and there was no significant difference in postoperative complications between different types of mediastinal uterus.Hysteroscopic metroplasty is a safe and feasible surgical method.Patients with uterine mediastinum with different types have strong fertility requirements can undergo surgical resection of the mediastinum and actively try pregnancy.