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...     

宫腔镜电切术治疗完全中隔子宫双宫颈阴道纵隔64例生殖预后分析

目的 探讨宫腔镜下子宫中隔电切除术对完全中隔子宫、双宫颈、阴道纵隔患者的治疗效果。方法 2004年9月至2013年8月浙江大学医学院附属妇产科医院完全中隔子宫、双宫颈、阴道纵隔住院患者64例,均行宫腔镜下子宫中隔电切除术及阴道纵隔切除术,分为反复流产组（26例）和不孕组（38例）,电话或门诊随访妊娠结局。结果 反复流产组25例妊娠,累计妊娠31次,自然流产率由术前83.1%（54/65）下降为41.9%（13/31）,足月产率、早产率和活产率分别为35.5%（11/31）、19.3 %（6/31）和54.8%（17/31）,与术前比较差异均有统计学意义（P<0.05）;不孕组18例妊娠,妊娠率47.4%（18/38）,其中12例足月分娩。研究对象中早产及足月产共32例,早产率28.1%（9/32）,足月产率71.9%（23/32）。研究对象胎盘粘连、植入发生率21.9%（7/32）,产后出血发生率25.0%（8/32）。结论 宫腔镜下子宫中隔电切除术可提高完全中隔子宫、双宫颈、阴道纵隔患者的妊娠率及生殖预后。     

宫腔镜下子宫纵隔切除术后生育结局分析

目的 探讨宫腔镜下子宫纵隔切除术（transcervical resection of uterine septum,TCRS）及术中同时处理子宫内膜异位症、子宫肌瘤后对生育结局的影响。方法 回顾性分析北京协和医院2017年2月至2020年4月收治的126例行宫腔镜下子宫纵隔切除术患者病历资料,跟踪随访生育结局,最终纳入84例有妊娠意愿且符合纳入标准的患者,对其手术前后的生育结局进行自身对照研究。结果 126例患者中失访12例（9.5%）。TCRS术后,纵隔子宫患者的妊娠率由64.3%显著升高到82.1%(P=0.009);纵隔子宫患者大部分的自然流产发生在早孕期,术后自然流产率显著降低,其中,早孕期流产率由56.9%～58.8%降至16.4%(P<0.001),中孕期流产率由18.6%～20.6%降至2.7%(P=0.001);活产率由术前4.9%显著升高至术后58.9%(P<0.001)。单纯行纵隔切除术的患者与同时处理子宫肌瘤、子宫内膜异位症的患者相比,手术后的生育结局差异无统计学意义（P>0.05）。结论 TCRS能显著改善患者生育结局,提高妊娠率、活产率,降...     

宫腔镜下子宫完全纵隔电切术93例患者的妊娠结局及影响因素

目的:分析腹腔镜监护宫腔镜下子宫纵隔电切术治疗93例子宫完全纵隔患者的生殖预后情况及其影响因素。方法:回顾性分析2008年3月至2017年6月南京医科大学附属妇产医院收治的具有完整随访资料的93例子宫完全纵隔患者的临床资料,进行电话追踪及门诊随访妊娠情况,统计分析妊娠情况及影响术后妊娠的相关因素。结果:对93例患者的术后生育情况进行跟踪记录,随访12～24个月,随访中位数20个月。(1)术后76例(81.72%)获得妊娠,累计妊娠次数83次,其中流产累计24人次,活产累计59例;59例活产中,47例(79.66%)剖宫产,12例(20.34%)顺产。与手术前比,手术后妊娠人次和活产人次增加,人均妊娠次数和流产人次减少,差异有统计学意义(P<0.05)。(2)宫腔镜二次探查后1个月妊娠13例(17.11%),2个月妊娠14例(18.42%),半年内共计妊娠46例(60.53%),术后1年共计妊娠61例(80.26%)。(3)妊娠患者的年龄、阴道纵隔、宫腔粘连与未妊娠患者比较,差异无统计学意义(P>0.05);而无盆腔粘连、有流产史和输卵管通畅的患者妊娠率更高,差异有统计学意义(P<0.05)。Logistic回归进行多因素分析,盆腔粘连(OR 8.802,95%CI 6.035～10.635)、流产史(OR 5.053,95%CI 3.256～12.369)为术后妊娠的危险因素,输卵管畅通(OR 0.051,95%CI 0.016～0.436)为术后妊娠的保护因素。结论:腹腔镜监护宫腔镜下子宫纵隔切除术可以显著降低子宫完全纵隔患者的自然流产率,提高妊娠率和活产率,改善妊娠结局。盆腔粘连、流产史、输卵管是否畅通是影响子宫纵隔切除术后患者妊娠的独立危险因素。     

宫腔镜子宫纵隔切开术治疗纵隔子宫

诊断纵隔子宫的金标准仍然是宫腔镜联合腹腔镜手术。文章阐述宫腔镜子宫纵隔切开术的手术技巧,回顾分析190例纵隔子宫患者术后的妊娠结局。宫腔镜下子宫纵隔切开术可减少流产率,提高活产率。宫腔镜下子宫纵隔矫形手术安全,并发症少,可明显改善纵隔子宫合并不良孕产史患者的妊娠结局。     

156例宫腔镜下子宫纵隔切除术后的生殖预后

目的探究和分析宫腔镜下子宫纵隔切除术(TCRS)的手术指征及生殖预后。方法采用回顾性研究方法,选择北京市平谷区医院及首都医科大学附属北京天坛医院2013年1月至2019年12月接收的156例纵隔子宫患者为主要对象,所有患者均实施宫腔镜下子宫纵隔切除术治疗,术后随访2~6年,分析患者术后妊娠及分娩结局。结果(1)25例有生育要求的患者行预防性切除子宫纵隔,术后22例(88.0%)妊娠,其中16例分娩(64.0%),6例流产(24.0%);(2)术中无1例发生子宫穿孔,出血及经尿道前列腺电切(TURP)综合征。术后无妊娠期子宫破裂发生。发生宫腔粘连5例(3.2%),均为轻微粘连;(3)不孕率、自然流产、稽留流产率分别由术前的21.9%、22.8%、29.8%降至8.4%、10.8%、7.2%,足月分娩率及活产率由术前的1.8%、2.6%升至66.3%、69.9%,术后妊娠率72.5%,手术前后比较差异有统计学意义(P<0.05)。结论对于诊断为子宫纵隔并且有生育要求的患者,建议进行预防性切除子宫纵隔;宫腔镜下子宫纵隔切除手术(TCRS)微创、安全、有效,能够明显改善其妊娠结局。     

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。     

宫腔镜电切治疗子宫纵隔临床分析

目的 探讨官腔镜电切术在治疗子宫纵隔中的作用。方法对39例子宫纵隔患者的诊断及在B超监护下行官腔镜子宫纵隔电切术的效果进行回顾性分析。结果B超诊断符合率82．05％(32／39)，子宫输卵管造影诊断符合率51．28％(20／39)，宫腔镜诊断符合率100％(39／39)。术中均采用B超监护，手术顺利，无并发症发生。术后随访39例，流产率由术前的89．74％降至术后的43．24％(16／37)，妊娠率为94．87％(3。7／39)，其中11例已足月妊娠分娩。结论官腔镜检查是诊断子宫纵隔的最准确的方法，B超监护下的宫腔镜电切术是治疗子宫纵隔的理想方法。     

不同类型子宫畸形及手术治疗对生育能力及妊娠结局的影响

目的:研究不同类型子宫畸形及纵隔子宫手术治疗对生育能力、妊娠并发症及妊娠分娩结局的影响。方法:将361例子宫畸形分类进行对比分析,并对58例纵隔子宫进行术前、术后对比研究。结果:单角子宫组的不孕症发生率、早产率、胎位异常率、胎儿宫内发育受限率及围产儿死亡率均高于其它子宫畸形组(P0.05),纵隔子宫早期胎儿丢失率最高(P0.05)。纵隔子宫术后胎儿丢失率较术前下降(P0.05),而足月产率、出生体质量增高(P0.05)。结论:单角子宫对妊娠及其结局影响较大,纵隔子宫易导致早期胎儿丢失,宫腔镜子宫纵隔电切术有助于改善妊娠与分娩结局。     

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。     

Clinical implications of congenital uterine anomalies: a meta-analysis of comparative studies

The clinical implications of congenital uterine anomalies (CUA), and the benefits of hysteroscopic resection of a uterine septum, were evaluated. Studies comparing reproductive and obstetric outcome of patients with and without CUA and of patients who had and had not undergone hysteroscopic resection of a uterine septum, were evaluated. Meta-analysis of studies indicated that the pregnancy rate was decreased in women with CUA (RR 0.85, 95% CI 0.73 to 1.00; marginally significant finding, P = 0.05). The spontaneous abortion rate was increased in women with CUA (RR 1.68, 95% CI 1.31 to 2.15). Preterm delivery rates (RR 2.21, 95% CI 1.59 to 3.08), malpresentation at delivery (RR 4.75, 95% CI 3.29 to 6.84), low birth weight (RR 1.93, 95% CI 1.50 to 2.49) and perinatal mortality rates (RR 2.43, 95% CI 1.34 to 4.42) were significantly higher in women with CUA. Hysteroscopic removal of a septum was associated with a reduced probability of spontaneous abortion (RR 0.37, 95% CI 0.25 to 0.55) compared with untreated women. Presence of CUA might be associated with a detrimental effect on the probability of pregnancy achievement, spontaneous abortion and obstetric outcome. Hysteroscopic removal of a septum may reduce the probability of a spontaneous abortion.     

Hysteroscopic metroplasty improves gestational outcome in women with recurrent spontaneous abortion

STUDY OBJECTIVE: To compare the reproductive outcome in women with recurrent spontaneous abortion (RSA) associated with septate uterus after hysteroscopic metroplasty compared with patients who did not undergo surgery. DESIGN: Longitudinal evaluation (Canadian Task Force classification II-2). SETTING: University of Rome, Tor Vergata-affiliated endoscopic unit. PATIENTS: Forty-eight consecutive women with septate uterus and RSA were enrolled in the study. INTERVENTIONS: Hysteroscopic metroplasty. MEASUREMENTS AND MAIN RESULTS: Reproductive outcome in terms of term pregnancy was significantly improved after hysteroscopic metroplasty compared with controls (76% vs. 20%). No differences were found in the prevalence of preterm delivery between groups (4% vs. 5%). CONCLUSION: Our data suggest that hysteroscopic septum incision can improve pregnancy outcome in patients with RSA associated with septate uterus.     

Hysteroscopic treatment of uterine septum

Authors report their 4 years experience in the treatment of uterine septum by hysteroscopic metroplasty. 35 patients underwent procedure; no complications occurred. Postoperative reproductive outcome was evaluated in 29 women with follow-up longer than 6 months. Patients were divided into 2 groups according to presence or absence of associated factors compromising fertility. Group A composed of 19 women in which uterine septum was the only cause of pregnancy wastage. Preoperatively they had 40 pregnancies all ending in spontaneous abortion. Postoperatively 15 (79%) patients conceived and 13 (68%) had a live baby. Totally they had 18 pregnancies, 2 (12%) ended in abortion, 1 in molar pregnancy, 1 in premature delivery, 11 delivered at term and 3 are currently beyond 20 weeks pregnant, for a live birth rate of 78%. Life table analysis showed an estimated pregnancy rate of 82% at 12 months, monthly fecundability was 0.13. Group B composed of 10 women in which other factors compromising fertility were present. Preoperatively only 5 experienced pregnancy. Totally they had 8 pregnancies 7 (86%) of which ended in abortions and one in extrauterine pregnancy. Postoperatively only 3 (30%) had pregnancy and all had a live baby. Totally they had 4 pregnancies, 1 ended in abortion and 3 at term for a live birth rate of 75%. Life table analysis showed an estimated pregnancy rate of 11% at 12 months, monthly fecundability rate was 0.01. Hysteroscopic metroplasty proved to be safe and effective for solving pregnancy wastage caused by uterine septum. If other factors compromising fertility were present metroplasty did not increase fecundability, but improved live birth rate.(ABSTRACT TRUNCATED AT 250 WORDS)     

Small-diameter hysteroscopy with Versapoint versus resectoscopy with a unipolar knife for the treatment of septate uterus: a prospective randomized study

STUDY OBJECTIVE: To compare 2 procedures for metroplasty: resectoscopy with monopolar knife versus small-diameter hysteroscopy fitted with a Versapoint device. DESIGN: Prospective randomized study (Canadian Task Force classification I). SETTING: Endoscopic gynecology units at tertiary care university hospitals. PATIENTS: One hundred-sixty patients with septate uterus and a history of recurrent abortion or primary infertility undergoing hysteroscopic metroplasty from 2001 to 2005. INTERVENTIONS: Hysteroscopic resection of the uterine septum performed with either a 26F resectoscope with unipolar knife (80 women, group A) or a 5-mm diameter hysteroscope with Versapoint device (80 women, group B). All patients were managed expectantly, with follow-up lasting 1 year. MEASUREMENTS AND MAIN RESULTS: Operative parameters (operative time, fluid absorption, complications, need for second intervention) and reproductive outcome parameters (pregnancy, abortion, term and preterm delivery, modality of delivery, cervical cerclage) were measured. Operative time and fluid absorption were significantly greater in group A than in group B (23.4 +/- 5.7 vs 16.9 +/- 4.7 minutes and 486.4 +/- 170.0 vs 222.1 +/- 104.9 mL, respectively). The cumulative complication rate was significantly lower in group B than in group A. No difference in any of the reproductive parameters was observed between the 2 groups: pregnancy and delivery rates were 70% and 81.6% in group A vs 76.9% and 84% in group B. Nine women (18.4%) from group B and 8 women (16%) from group B experienced spontaneous abortions. Most patients (54/82) delivered by cesarean section without differences according to the hysteroscopic technique used for metroplasty (65% in group A vs 67.7% in group B) or to the gestational age (65.1% of term and 68.7% of preterm deliveries). CONCLUSIONS: Small-diameter hysteroscopy with bipolar electrode for the incision of uterine septum is as effective as resectoscopy with unipolar electrode regarding reproductive outcome and is associated with shorter operating time and lower complication rate.     

Reproductive outcomes after Versapoint hysteroscopic metroplasty

ObjectiveTo determine the feasibility, safety and the outcomes of hysteroscopic metroplasty with bipolar Versapoint electrode.DesignProspective, observational study.SettingEndoscopy Unit, Suzan Moubark Maternity and Pediatric University Hospital.Patient(s)Twenty-six patients with different degree of uterine septa and poor reproductive outcomes (spontaneous abortion, habitual abortion, preterm labor and unexplained primary infertility).Intervention(s)Versapoint hysteroscopic division of the uterine septum.Main outcome measure(s)Prospective evaluation of the reproductive outcomes during 24months follow up.Result(s)There was significant changes in the results after metroplasty, as 23 (88.46%) patients became pregnant, of them 3/23 (13.04%) had habitual abortion, 2 patients (4.34%) ended in preterm labor, 14/23 (60.86%) had reached to term delivery with a total pregnancy loss of 5/23 (21.73%) and pregnancy complications occurred in 5/23 (21.73%), these results represent a statistically significant difference (P?0.05). The mean gestational age, the mean neonatal weight at delivery, early neonatal condition judged by apgar scores both in 1 and 5min after delivery were significantly improved after hysteroscopic metroplasty (P<0.05). There were no intraoperative or postoperative complications, and complete removal of the septum was achieved in 21 patients (80.67%), a residual septum was found in 5 woman (19.23%), and a 2nd intervention was done in only 2 patients (7.69%) with a residual septum >1cm using office hysteroscopy.Conclusion(s)Hysteroscopic metroplasty using the Versapoint is a successful alternative to the resectoscope technique; it has the same effectiveness and broad safety profile with its simplicity, minimal postoperative squeal, and improved reproductive outcome, this approach should be recommended for metroplasty.     

Hysteroscopic management in submucous fibroids to improve fertility

Objective: To evaluate prospectively the reproductive performance following hysteroscopic myomectomy in women with submucous fibroids and wishing a pregnancy. Study design: Twenty-nine consecutive women wishing a pregnancy with a previously diagnosed submucous fibroid as a sole cause for reproductive failure were treated by hysteroscopic myomectomy. Fourteen women suffered from primary infertility and 15 women had previous pregnancies with a poor obstetric outcome. The myomas were intracavitary (n=25) and intramural class 1 (n=4). None of the patients had type 2 or multiple submucousal fibroids. Myoma size was not larger than 5 cm (the mean was 13.3 mm). Before myomectomy, the outcome reproductive data were recorded prospectively. Following myomectomy, the cumulative rate of first pregnancies, live birth rate and the hysteroscopic anatomical results were assessed and compared with that before surgery. Results: The mean duration of follow-up before and after myomectomy was comparable. Twenty-one women (72.4%) experienced 30 pregnancies after myomectomy. Thirteen women gave birth to16 live infants. Compared with previous pregnancies, the rate of deliveries increased from 3.8% to 63.2% and the abortion rate decreased from 61.6% to 26.3%. No complications occurred during myomectomy. The hysteroscopic anatomical results were good in the majority of cases. Conclusions: This prospective study demonstrates that hysteroscopic myomectomy at present is the method of choice to improve the cumulative pregnancy rate as well as the live birth rate in selected women with submucous myomas and a history of reproductive failure.     

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。     

Effect of Hysteroscopic Metroplasty on Reproductive Outcomes in Women with Septate Uterus: Systematic Review and Meta-Analysis

ObjectiveThe aim of this systematic review with meta-analysis is to evaluate the impact of hysteroscopic metroplasty on adverse reproductive outcomes such as miscarriage, preterm birth, and fetal malpresentation in patients with history of infertility or previous poor obstetrical outcomes.Data SourcesA systematic electronic search from inception each database up to April 2021 including the following databases was conducted: PubMed-MEDLINE, EMBASE, Web of Science, The Cochrane Library, the CGF Specialized Register of Controlled Trials, Google Scholar, and trial registries. A combination of the following keywords was used: uterine septum, septate uterus, congenital uterine malformation, class 2 uterus, class V uterus, metroplasty, hysteroscopic, pregnancy, clinical pregnancy, ongoing pregnancy, miscarriage, live birth, preterm birth, cesarean section, ‘cesarean delivery, and fetal malpresentation.Methods of Study SelectionStudies comparing reproductive outcomes between women undergoing hysteroscopic resection of the uterine septum and those with expectant management were included. Eligible population consisted of infertile women, women with poor obstetrical history, or women without previous pregnancy failures and a diagnosis of septate uterus.Tabulation, Integration, and ResultsThe systematic electronic search retrieved 1076 studies; after elimination of duplicates, 688 titles and abstracts were screened, and 55 were assessed for eligibility. Eleven studies were included in the quantitative synthesis: one randomized controlled trial and 10 observational studies involving reproductive outcomes from 1589 patients with either complete or partial uterine septum. The pooled OR for miscarriage was 0.45, (95% CI, 0.22?0.90). When the analysis was performed considering subgroups according to the type of septum, pooled OR in complete septum subgroup was 0.16 (95% CI, 0.03?0.78), OR = 0.36 (95% CI, 0.19?0.71) in the partial septum subgroup and 0.58 (95% CI, 0.20?1.67) in those studies not differentiating between complete or partial septum. No significant differences were found between the 2 groups in OR of clinical pregnancy, term live birth, or risk of cesarean delivery. There was a significant decrease in the frequency of preterm birth in patients who underwent partial septum resection (OR = 0.30, 95% CI, 0.11?0.79). This difference was detected neither in patients with complete septum nor in studies not differentiating between partial or complete septum. The risk of fetal malpresentation was also significantly reduced (OR = 0.32, 95% CI, 0.16?0.65).ConclusionThe results of the present meta-analysis support that hysteroscopic metroplasty is effective in reducing the risk of miscarriage in patients with complete or partial uterine septum, although these data should be confirmed with a well-designed randomized controlled trial.