合并阴道纵隔双宫颈的完全中隔子宫27例临床分析

目的：探讨宫腹腔镜联合矫治合并阴道纵隔双宫颈的完全子宫中隔的临床效果。方法：收集2012—2013年首都医科大学附属北京妇产医院妇科微创中心27例宫腹腔镜联合矫治合并阴道纵隔双宫颈的完全中隔子宫患者的临床资料,其中原发不孕7例,自然流产10例,稽留流产3例,不良孕史7例。结果：27例患者一次手术成功率为100%,未发生术中、术后并发症。27例随访30～53个月,平均（41.56±6.33）个月。足月活产18例,早产1例,自然流产2例,未孕3例,因胎儿畸形引产1例,术后1例失访,3例术后因个人或疾病原因暂无妊娠计划,一直避孕。本组患者妊娠率由术前52.17%（11/23）上升至术后86.96%（20/23, χ2=6.33,P=0.01）,而活产率由术前0（0/23）上升至术后82.61%（19/23,P=0.000）,流产率由术前47.83%（11/23）下降至术后8.70%（2/23, χ2=6.86,P=0.008）,差异均有统计学意义。结论：宫腹腔镜联合矫治合并阴道纵隔双宫颈的完全中隔子宫安全、有效,能显著改善患者生殖预后,提高妊娠率和活产率,降低流产率。     

宫颈环扎术治疗完全性纵隔子宫并双宫颈双阴道一例并文献复习

先天性子宫畸形合并宫颈功能不全发病率可高达30%。纵隔子宫作为一种先天性子宫畸形,育龄妇女患病率约为0.2%～2.3%;具有较高的不孕、流产和早产风险。报告1例完全性纵隔子宫并双宫颈双阴道患者,妊娠前宫腔镜下行子宫纵隔切除术,孕14周经阴道行双侧宫颈预防性环扎术,孕23+6周宫口开大,保守治疗,孕30+1周早产临产拆线,最终自然分娩并抱婴回家的临床处置经过,并回顾总结近年国内外纵隔子宫合并妊娠的诊治进展。     

宫腔镜子宫中隔畸形切除术生殖预后分析

目的 :探讨宫腔镜子宫中隔切除术 (TCRS)对不孕者的治疗预后。方法 :对 111例子宫中隔导致不孕患者按其妊娠情况分为反复流产组 (77例 )和不孕组 (34例 ) ,进行宫腔镜子宫中隔切除术并对术后生殖情况进行前瞻性研究。结果 :反复流产组 5 6例妊娠 ,累计妊娠 6 2次 ,自然流产率由术前 84 1% (180 / 2 14 )下降为 2 9 0 % (18/ 6 2 ) ,足月产率与活产率分别由手术前 3 3% (7/ 2 14 )、10 % (2 / 2 0 )上升至 5 8 9% (33/ 5 6 )和 97 4 % (37/ 38) ,P <0 0 1;不孕组有 15例妊娠 ,妊娠率 4 4 1% (15 / 34) ,其中 12例已经足月分娩 ,活产率 10 0 % (12 / 12 )。结论 :宫腔镜子宫中隔切除术明显改善子宫中隔所致不孕不育患者的生殖预后 ,是矫治子宫中隔的理想手术方法     

子宫纵隔-双宫颈-阴道纵隔10例分析

目的 探讨子宫纵隔-双宫颈-阴道纵隔的诊治经验。方法 检索北京协和医院病案科1984年至今的电子病案数据库,调集相关病例系统复习,根据手术记录对畸形描述进行复核和甄别。10例子宫纵隔-双宫颈-阴道纵隔特异畸形病例通过门诊病历和电话完善随访。结果 10例均有不孕病史,完全分隔的双宫颈患者除1例行开腹子宫纵隔切除术外,均行腹腔镜检查+宫腔镜子宫纵隔切除术+阴道纵隔切除术。自然受孕并足月剖宫产3例,距前次手术间隔2~3.5年。结论 在不孕症诊治中存在子宫纵隔-双宫颈-阴道纵隔这种较为复杂的生殖道发育畸形。治疗上双宫颈不需处理,子宫纵隔的切除首选宫腔镜。     

宫腔镜治疗子宫纵隔的产科结局分析

目的：探讨宫腔镜子宫纵隔电切术后患者的产科结局。方法：收集231例行宫腔镜子宫纵隔电切术患者的信息,电话随访患者术后恢复情况及妊娠情况。结果：所有患者均于腹腔镜或超声监视下一次性完成手术,术中无子宫穿孔、大出血等并发症发生,术后电话随访6～30个月,月经量均无明显改变,无宫腔粘连发生。161例患者于术后2～25个月成功妊娠,妊娠率69.7%（161/231）;21例患者自然流产,流产率13.0%（21/161）;14例患者因胎膜早破早产,早产率10.0%（14/140）。不同年龄组妊娠率相比较,术后妊娠率均高于术前妊娠率,差异有统计学意义（P＜0.05）。低年龄组术后妊娠率虽较高年龄组升高,但差异无统计学意义（P＞0.05）。结论：宫腔镜下子宫纵隔电切术能够有效改善患者的产科结局,明显提高妊娠率及活产率,降低流产率。对于早期发现纵隔子宫畸形的患者,应尽早手术治疗,提高妊娠率。     

三维阴道超声检查和宫腔镜子宫中隔切除术在不孕症中的应用

目的:探讨三维阴道超声(3 D-TVS)诊断后在门诊行宫腔镜下子宫中隔切除术在治疗中隔子宫不孕症患者中的应用价值.方法:选择2008年1月至2011年10月我院经3 D-TVS初步诊断为中膈子宫且未合并盆腔病变的不孕患者71例,其中原发不孕24例,继发不孕47例.全部患者在门诊宫腔镜检查确诊中膈子宫后行子宫中隔切除术及双输卵管插管通液术.术后随访妊娠率及妊娠结局.结果:①经宫腔镜确诊,不完全中隔子宫53例,完全中隔子宫18例.3D-TVS诊断中隔子宫符合率为100.0％ (71/71),明显高于二维经阴道超声(2D-TVS)诊断符合率73.2％ (52/71)和输卵管造影(HSG)诊断符合率59.2％ (42/71),差异有高度统计学意义(P＜0.01).②100％ (71/71)患者1次子宫中隔切除术成功重建宫腔,无手术并发症.术后宫腔镜复查85.9％ (61/71)宫腔形态正常,14.1％( 10/71)宫腔轻度鞍型,输卵管插管术后通畅率达96.5％ (137/142).③原发不孕患者术后妊娠率70.8％ (17/24).继发不孕患者自然流产率由术前84.1％ (58/69)下降为18.6％( 8/43),足月妊娠率由术前2.9％(2/69)上升到74.4％( 32/43),新生儿存活率由术前的5.8％ (4/69)上升到74.4％( 32/43),上述各指标手术前后比较,差异均有高度统计学意义(P＜0.01).结论:3 D-TVS对中隔子宫的准确诊断是门诊无监护宫腔镜术的前提.3D-TVS诊断后在门诊行宫腔镜下子宫中隔切除术安全、可行,患者损伤小,是治疗未合并盆腔病变的中隔子宫不孕症患者的一种有效方法.     

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

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...     

宫腔镜联合腹腔镜手术治疗完全纵隔子宫伴阴道纵隔的临床疗效

目的:探讨宫腔镜联合腹腔镜手术治疗完全纵膈子宫伴阴道纵隔的临床效果。方法:回顾性分析我院妇科微创中心行腹腔镜监护下宫腔镜子宫纵隔切除+阴道纵隔切除术的40例完全纵隔子宫伴阴道纵隔患者的临床资料,并随访其术后妊娠结局。结果:40例患者成功随访1~6年,术后累计妊娠46次,自然流产率由术前的87.3%下降到30.4%,足月活产率由0.0%上升到58.7%,无胎盘植入、胎盘粘连等妊娠期并发症发生。结论:宫腔镜联合腹腔镜手术安全有效,可明显改善纵隔子宫合并阴道纵隔患者的妊娠结局,不增加孕期并发症,建议在临床上推广应用。     

电视宫腔镜下子宫纵隔电切术与剪除术效果比较

我院自1996年2月至2003年12月开展了电视宫腔镜下子宫纵隔切除术,收到了较好的效果。现报道如下。1临床资料1.1一般资料因子宫畸形而要求手术病例共68例,其中子宫纵隔患者48例(完全纵隔2例,不完全纵隔46例)。年龄21～33岁。原发不孕3例,继发不孕3例,除原发不孕3例外,均有自然流产或早产史,45例患者中人工流产11次,自然流产113次,胎死宫内4例,早产7例(新生儿死亡6例)。自然流产平均(2.35±1.23)次(1～5次),22例自然流产≥3次。20例行宫腔镜下微型剪刀子宫纵隔剪除术(微型剪刀组),28例行宫腔镜下子宫纵隔电切术(电切组)。1.2方法(1)术前准备:…     

子宫纵隔手术的近期、远期并发症及生殖预后

子宫纵隔是女性生殖道畸形中最常见类型,引起不孕、反复流产、早产及胎膜早破,影响其妊娠结局,需手术矫治。经宫颈子宫纵隔切除术是治疗子宫纵隔的金标准方法,是宫腔镜手术成功的代表作。宫腔镜下子宫纵隔切除手术微创、安全、有效,能够明显改善其妊娠结局。手术并发症包括子宫穿孔、体液超负荷、出血、纵隔残留、宫腔粘连及远期妊娠子宫破裂等。本文主要探讨其发生原因及预防方法。虽然近、远期手术并发症罕见,但临床上不容忽视,提高手术安全性,才能体现宫腔镜手术微创优势。     

The diagnosis and reproductive outcome after surgical treatment of the complete septate uterus, duplicated cervix and vaginal septum

OBJECTIVE: This study was undertaken to evaluate the diagnostic management and the reproductive outcome after surgical repair of a rare reproductive malformation. STUDY DESIGN: Sixteen women with a complete septate uterus, double cervix, and a longitudinal vaginal septum were referred for evaluation. Presenting complaints were chiefly pregnancy loss in parous women (n=9) and dyspareunia in nulligravid women (n=7). The combination of hysterosalpingography, ultrasonography, and/or magnetic resonance imaging was used to correctly identify the anomaly in 15 of the 16 cases. Both hysteroscopic (n=11) and transabdominal (n=5) surgical techniques were used to repair the uterine septum. RESULTS: In no case was the correct diagnosis made before referral; the uterus didelphys was the most common misdiagnosis. The preoperative pregnancy loss was 81%. Postoperatively, 12 women conceived for a total of 17 pregnancies; there were 14 term live births or ongoing pregnancies in the third trimester (82%), with a first trimester spontaneous abortion rate of 18%. In 9 women who conceived after hysteroscopic surgery, term live births occurred in 9 of 12 (75%) conceptions. A modified Tompkins metroplasty was performed in 5 women with subsequent term live births or ongoing third trimester pregnancies in 5 of 5 (100%) patients. CONCLUSION: The identification of a duplicated cervix and a vaginal septum is consistent with several uterine malformations, which leads to frequent misdiagnosis and errors in management. Significant pregnancy wastage, obstetric complications, and dyspareunia are common, and surgical treatment is therefore advisable. Making the best choice between hysteroscopic or transabdominal metroplasty depends on the anatomic features of the cervix and the uterine cavity, but optimal patient management requires familiarity with both techniques.     

Management and reproductive outcome of complete septate uterus with duplicated cervix and vaginal septum: review of 21 cases

Aim

To evaluate the reproductive outcomes of complete septate uterus with duplicated cervix and vaginal septum.

Methods

Twenty-one patients who have complete septate uterus with duplicated cervix and vaginal septum were retrospectively reviewed in this study. In Group I, 11 patients with a poor reproductive outcome (spontaneous miscarriage or infertility) or dyspareunia underwent hysteroscopic metroplasty and removal of vaginal septum with the preservation of cervical septum. In Group II, 10 patients without a history of spontaneous miscarriage did not undergo hysteroscopic transection of the uterine septum. Of 10, four underwent vaginal septum incision due to dyspareunia, two underwent mere laparoscopic pelvic adhesiolysis because of infertility, and four without symptoms had no intervention. The primary endpoints included the pregnancy rate and outcomes of pregnancies.

Results

In Group I, the pregnancy rate after surgery is 81.8 % (9/11). Of nine women who conceived, six had term delivery, one encountered induced abortion due to the malformation of the fetal heart, and two had ongoing pregnancy. In Group II, among six patients accepting surgery, three had term delivery. The pregnancy rate after operation is 50 % (3/6).

Conclusions

The uterine septum may not necessarily be transected for patients who have complete septate uterus with duplicated cervix and vaginal septum, and meanwhile have no a history of poor reproductive outcome.     

Light-Guided Hysteroscopic Resection of Complete Septate Uterus With Preservation of Duplicated Cervix

The objective of the present study, performed at a tertiary university hospital, was to propose a novel method of hysteroscopic resection of complete septate uterus with preservation of duplicated cervix. The retrospective study included 5 women with complete septate uterus and cervical duplication and who also experienced infertility with or without pregnancy loss. All patients underwent bougie-guided or light-guided hysteroscopic perforation of the uterine septum above the endocervix, followed by septum resection. The success rate of complete uterine septum perforation under bougie guidance was 60% (3 of 5 procedures), and of light guidance was 100% (2 procedures). After hysteroscopic septum resection, 2 of 5 women achieved pregnancy within 3 months and delivered uneventfully at term. It is concluded that light guidance is superior to bougie guidance for hysteroscopic perforation of complete septate uterus with preservation of the duplicated cervix.     

Septate uterus with cervical duplication: a full-term delivery after resection of a vaginal septum

We report a full-term delivery after resection of a longitudinal vaginal septum in a patient with a septate uterus and cervical duplication.     

The outcome of singleton pregnancies after IVF/ICSI in women before and after hysteroscopic resection of a uterine septum compared to normal controls

Objective(s)

To evaluate the effect of hysteroscopic resection of a large uterine septum (Class V according to the American Fertility Society (AFS) classification) and of a small partial uterine septum (Class VI according to AFS classification or arcuate uterus) on the abortion rate in pregnancies after IVF and ICSI.

Study design

The retrospective matched control study included 31 women who conceived following IVF or ICSI before hysteroscopic resection of a large (12 women) or small partial (19 women) uterine septum and 106 women who conceived following IVF or ICSI after hysteroscopic resection of a large (49 women) or small partial (57 women) uterine septum. For each pregnancy in the study group, we found two consecutive pregnant control women from the IVF/ICSI registry who had a normal uterus and were matched for age, BMI, stimulation protocol and the use of IVF or ICSI and for various infertility causes. The abortion/pregnancy rate was the main outcome measure. Data on the septum length were obtained during hysteroscopic resection by comparing the length of the 1.4 cm long yellow tip of the electric knife to the length of the resected septum.

Results

The abortion rate before hysteroscopic metroplasty was significantly higher, both in women with a small partial septum (78.9% before resection vs. 23.7% in the normal controls, OR 12.08) and a large septum (83.3% before resection vs. 16.7% in normal controls, OR 25.00) compared to women with a normal uterus. After the surgery, the abortion rate was comparable to the abortion rate in women with normal uterus: in both women with a small partial and women with a larger septum.

Conclusion(s)

Similar to a large uterine septum, a small partial uterine septum is an important and hysteroscopically preventable risk factor for spontaneous abortion in pregnancies after IVF and ICSI.     

Septate uterus with double cervix and longitudinal vaginal septum. A case report.

BACKGROUND: Congenital uterine anomalies in the general population are estimated to have an incidence of 0.001-10%. The septate uterus, the most common form of structural uterine anomaly, has the highest reproductive failure rate. A rare developmental variant is a septate uterus with cervical duplication and a complete longitudinal vaginal septum. The existence of this anomaly challenges classical müllerian developmental theory. Traditional transabdominal metroplasty has been replaced by operative hysteroscopy in the surgical correction of a septate uterus, with laparoscopy aiding in the diagnosis and contributing to the safety and efficiency of the procedure. CASE: A 28-year-old, nulliparous woman with a septate uterus with cervical duplication and complete longitudinal vaginal septum was diagnosed by combined laparoscopy and hysteroscopy. Excision of the complete longitudinal vaginal septum followed by hysteroscopic partial resection of a thick uterine septum with laparoscopic assistance was performed. However, because of the septum's broad base and the rigidity of the operative resectoscope, we opted to proceed with transabdominal metroplasty. CONCLUSION: Only six cases of septate uterus with cervical duplication and complete longitudinal vaginal septum have been reported. Although its counterpart, the septate uterus, has effects on preterm labor, fetal presentation, infertility and spontaneous abortion, its reproductive outcome has not been assessed. Review of the literature suggests that surgical correction in the setting of poor reproductive outcome has been beneficial. Laparoscopically assisted hysteroscopic resection of the uterine septum is a safe, effective surgical technique of uterine reunification and is preferable to transabdominal methods. However, in certain cases, conventional transabdominal metroplasty may still be required.     

Pregnancy and delivery after hysteroscopic metroplasty

AIM OF THE STUDY: Outcomes of treatment of habitual miscarriages and course of pregnancy and delivery in women after hysteroscopic metroplasty i.e. hysteroscopic resection of uterine septum. MATERIAL AND METHODS: Material consisted of 31 women with uterine septum operated between years of 1995-2002 because of habitual miscarriage by surgical hysteroscopic technique. The control group consisted of 26 women treated between years of 1990-1997 by Strassman's operation. Outcomes of treatment of habitual abortions, course of pregnancy and delivery were analyzed in both groups. The statistical analysis was performed by Chi 2 test (p < 0.05). RESULTS: After such treatment 27 out of 31 hysteroscopic treated women became pregnant. In first pregnancy in 12 women miscarriages and in 3 cases premature delivery were observed. Twelve pregnant women delivered pregnancy till 37 week. 15 infants survived (3 premature baby). Out of 26 women in control group after Strassman's operation 24 became pregnant, but 12 had miscarried. All pregnancy in control group i.e. ten mature pregnancy and 2 during premature delivery were ended by Cesarean section. The efficacy of treatment of habitual miscarriage due to uterine septum by hysteroscopic surgery was 55.5%, and there was no statistical significant difference between hysteroscopic surgery and Strassman's operation (50.0%). CONCLUSIONS: On the basis of result obtained the hysteroscopic metroplasty should be method of choice in the treatment of the uterine septum. Although the vaginal delivery is preferred one should have in mind the late complications of hysteroscopic surgery.