宫腔镜下子宫纵隔切除手术对妊娠及产科结局的影响

目的:探讨宫腔镜下子宫纵隔切除术(transcervical resection of septum,TCRS)对患者的妊娠及产科结局的影响?方法:2006年3月~2011年5月使用宫腔镜电切术治疗166例子宫纵隔患者?利用病历资料?手术记录及电话随访,分析术前?术后妊娠结局并总结患者产科结局?结果:术中无严重并发症发生,术后首次妊娠距二探取环后最短1个月即妊娠,自然流产率从术前的64.53%降至术后的15.25%(P < 0.01),活产率从术前的1.89%上升至术后的72.03%(P < 0.01)?术后剖宫产率80%,无指征剖宫产达到总剖宫产数的41.12%,产后出血率23.53%,其中需要输血的占45%,1例先兆性子宫破裂?结论:宫腔镜下子宫纵隔切除术可以明显改善患者的妊娠结局,术后可尽快妊娠,加强孕期监督?分娩方式指导及预防产后出血发生可进一步改善其产科结局?

The pregnancy and obstetric outcome after transcervical resection of septum

Objective:To discuss the pregnancy and obstetric outcome of the patients after transcervical resection of septum(TCRS). Methods:We collected 166 patients with uterus septa from May 2006 to May 2011 from Nanjing Maternity and Child Health Hospital of Nanjing Medical University,and compared the pregnancy and obstetric outcome between pre-operation and post-operation with medical records,surgical records and telephone follow-up. Results:No serious complications occurred during operation,and the shortest duration from the remove of IUD to pregnancy was one month. After TCRS,the rate of spontaneous abortion decreased from 64.53% to 15.25%(P < 0.01),while the live birth rate increased from 1.89% to 72.03%(P < 0.01). The rate of cesarean section was 80%,in which the cesarean section without indications was 41.12%. Besides,the incidence of postpartum hemorrhage was 23.53%,in which the rate of blood transfusion patients was 45% including one threatened uterine rupture case in our study. Conclusion:TCRS could significantly promote the pregnancy and improve outcomes after surgery. Intensive pregnancy monitoring and sufficiently guidance were essential to improve the obstetric outcome and prevent postpartum hemorrhage.