宫腔镜下子宫纵隔电切术监护方法探讨

目的 探讨腹腔镜、超声方法对宫腔镜下子宫纵隔电切术术中监护的应用价值。方法 回顾性分析306例不同监护方法进行宫腔镜下子宫纵隔电切术患者的临床资料，其中不孕症患者110例，不良孕产史患者196例。分析术中发现和术后二次手术率及妊娠结局。结果 超声监护二次手术率为3．6％，腹腔镜监护二次手术率为2．3％，二者比较差异无显著性；对于不良孕产史患者，流产率由术前97．7％下降到术后25．5％，足月分娩率由术前0．5％上升到术后63．4％。两种监护方法术前、术后流产率，术前、术后足月产率比较差异均无显著性。结论 诊断明确的子宫纵隔患者，排除盆腔疾患，子宫纵隔电切术可选择无创、费用低的超声监护进行。不孕症合并子宫纵隔的患者应进行宫、腹腔镜联合手术。

Evaluation on guidance for transcervical resection of septum

[ Objective] To evaluate the clinical effect of laparosocpy and ultrasonography guidance for TCRS. [Method] 309 cases of TCRS with different ways of guidance were analyzed, including 110 cases of infertility, 296 cases of history of recurrence abortion or early pregnancy. Post- operative second operation rate and post-operative pregnancy prognosis were analyzed. [Result] Second operation rate for ultrasound and laparoscopy guidance are 3.6 % and 2.3% separately, there is no statistical significance, P=0.787. Post-operative pregnancy prognosis was significantly improved. Abortion rate decrease from 97.7% to 24.5%, term-delivery rate increase from 0.5% to 63.4%, live birth rate increase from 22.2% to 95.9%. There are no statistical difference between post-operative term-delivery rate and abortion rate, and no difference exists in pre-term delivery rate of the two different kinds of guidance way. [Conclusion] Ultrasonography should be the first line guidance way for TCRS, exclude the possibility of pelvic disease. For infertility patients with uterine septum, laparoscopic way of guidance should be adopt.