完全子宫纵隔、双宫颈、阴道纵隔的宫腔镜下子宫成形术

Objective: To determine if sectioning of the cervical septum in hysteroscopic metroplasty of the complete uterine septum is associated with intraoperative bleeding, cervical incompetence, and secondary infertility. Design: Multicenter, randomized, controlled clinical trial. Setting: University hospitals. Patient(s): Twenty-eight women with a diagnosis of complete uterine septum who had a history of pregnancy wastage or infertility. They were randomized into two groups: group A underwent metroplasty including section of the cervical septum; group B underwent the same procedure with preservation of the cervical septum. Intervention(s): Hysteroscopic metroplasty was performed for all patients in the two groups. Main Outcome Measure(s): Operating time, distending media deficit, total distending media used, intraoperative bleeding, complications, and reproductive outcome. Result(s): Operating times were 36.40 ± 10.67 minutes and 73 ± 14.40 minutes in group A and group B, respectively. Distending media deficit was 456.66 ± 165.68m Lin group A,while in groupB it was 673.84± 220.36. Two cases of pulmonary edema and three cases of significant bleeding ( > 150 mL)were seen in group B. The cesarean section rate was significantly higher in group B. There were no signifi cant differences in the reproductive outcome in the two groups. Conclusion(s): Resection of the cervical septum during hysteroscopic metroplasty of complete uterine septum makes the procedure safer, easier, and less complicated than the procedure with preservation of the cervical septum. This procedure is recommended for all cases of complete uterine septum.

腹膜移植成功治疗宫颈发育不全

Objective: To evaluate the efficacy of a peritoneal graft for the treatment of cervical aplasia. Method: Four patients with cervical aplasia who had a functioning endometrium and hematometra were recruited for this clinical trial. Through an abdominoperineal approach a plastic stent was inserted between the endometrial cavity and the upper part of the vagina; then, a graft of peritoneum was applied over the stent. In the absence of a vagina, grafts of skin or amniotic membrane were also used. The plastic stent was removed after 1 month in 2 patients and after 1 week in the 2 other patients. Result: After more than 1 year of observation the 4 patients had regular menstrual cycles with normal menstruation. Sonographic examinations also showed empty uterine cavities. Conclusion: Traditional gynecology textbooks recommend hysterectomy in cases of cervical aplasia. This report presents a new technique with 2 variations using a peritoneal graft. Although both variations were successful in the treatment of cervical aplasia in 4 women, more trials are needed to determine which one should be developed.

早期反复流产伴输卵管积水患者接受腹腔镜下输卵管膜阻断后的妊娠结局

Objective: To investigate the outcome of pregnancy following laparoscopic unilateral tubal fulguration of hydrosalpinges in patients with recurrent spontaneous early abortion. Design: Prospective randomized controlled trial. Setting: University tertiary center. Patient(s): Thirteen patients with history of unexplained recurrent early spontaneous abortion and a unilateral hydrosalpinx diagnosed by sonography and hysterosalpingography in whom other causes of abortion were excluded. Intervention(s): The treatment group (group I) consisted of seven women who underwent laparoscopic unilateral tubal fulguration. The control group (group II) consisted of six patients for whom no surgical intervention was performed. Main Outcome Measure(s): Continuation of pregnancy over first trimester. Result(s): Six patients in the treatment group and five in the control group conceived. Five patients in the treatment group and none in the control group had pregnancy beyond the first trimester and finally reached 36-40 weeks gestational age (P = .02). Conclusion(s): Laparoscopic tubal fulguration improves pregnancy outcome in selected patients with previous recurrent early abortion and a unilateral hydrosalpinx.