宫腔镜下子宫纵隔切除术后妊娠结局分析

Analysis of pregnancy outcome after hysteroscopic tanscervical resection of septum

目的回顾性分析宫腔镜下子宫纵隔切除术(tanscervical resection of septum,TCRS)后不同孕产史或不同纵隔类型患者的妊娠结局。方法选取2018年1月至2021年1月因子宫纵隔于郑州大学第三附属医院就诊并行宫腔镜下TCRS的145例患者为研究对象,术后随访3~24个月,观察其手术效果及妊娠情况。结果术后共119例(82.07%)患者获得妊娠,总计妊娠次数为132次,与术前相比,术后获得妊娠人数与活产人数增加,累计妊娠次数与流产次数降低(P<0.05)。不孕组患者术后25例(65.79%)获得妊娠,但仍有13例(34.21%)不孕,与术前相比差异具有统计学意义(P<0.01);既往妊娠组及复发性流产组患者术后流产率下降,活产率提高(P<0.05)。完全子宫纵隔患者术前较不全子宫纵隔患者更易发生不孕(P<0.001),术后完全子宫纵隔组及不全子宫纵隔组较术前,流产率下降,活产率提升,差异具有统计学意义(P<0.001)。Logistic回归分析结果显示,年龄是导致术后继发性不孕症的独立危险因素[OR=4.796,95%CI(1.916,12.007),P<0.001]。结论宫腔镜下TCRS是一种安全、微创且能改善妊娠结局的手术方式,对于有生育要求的子宫纵隔患者可行TCRS以提高妊娠率及活产率。

Objective To retrospectively analyze the pregnancy outcomes of patients with different pregnancy histories or different mediastinal types after hysteroscopic tanscervical resection of septum(TCRS).Methods A total of 145 patients with uterine septum who underwent hysteroscopic TCRS in The Third Affiliated Hospital of Zhengzhou University from January 2018 to January 2021 were selected as the study subjects.The patients were followed up for 3 to 24 months,and the surgical effects and pregnancy were observed and compared.Result 119(82.07%)patients achieved pregnancy after surgery,and the total number of pregnancies was 132.Compared with before surgery,the number of pregnancies and live births increased,and the cumulative number of pregnancies and abortions decreased,the difference was statistically significant(P<0.05).In the infertility group,25(65.79%)patients achieved pregnancy after surgery,but 13(34.21%)were still infertile,and the difference was statistically significant compared with that before surgery(P<0.01).The abortion rate of patients in the previous pregnancy group and the adverse pregnancy history group decreased,and the live birth rate of the two groups increased(P<0.05).Patients with complete uterine septum were more likely to have infertility than those with incomplete uterine septum before surgery(P<0.001).After surgery,the abortion rates of the complete uterine septum group and the incomplete uterine septum group decreased,and the live birth rates increased,and the differences were statistically significant(P<0.001).The results of Logistic regression analysis showed that age was an independent risk factor for postoperative secondary infertility[OR=4.796,95%CI(1.916,12.007),P<0.001].Conclusion The hysteroscopic TCRS is a safe and minimally invasive surgical manner that can improve pregnancy outcomes.For patients with septate uterus who have fertility requirements,this operation can improve pregnancy rate and live birth rate.