中隔子宫合并子宫内膜异位症宫腔镜腹腔镜联合手术后的治疗与妊娠结局

【目的】探讨中隔子宫合并子宫内膜异位症（Endometriosis，EMS）宫腹腔镜手术后的临床治疗。【方法】对2002年1月至2008年1月北京大学深圳医院住院治疗的40例中隔子宫合并子宫内膜异位症患者的临床资料进行回顾性分析。【结果】40例中隔子宫患者临床表现均为不孕不育，患者全部经宫腔镜加腹腔镜联合手术，腹腔镜诊断合并盆腔子宫内膜异位症。宫腔镜检查完全中隔13例，不全中隔27例。子宫内膜异位症按（ASF-r）分期，为I～Ⅱ期。所有患者术后均加用雌激素治疗3个月，并放置宫内节育器2～4个月防止宫腔粘连。追踪随访妊娠21例，分娩16例，妊娠率52．5％。【结论】中隔子宫患者易合并盆腔子宫内膜异位症，应早期诊断、早期手术。宫腹腔镜联合手术是首选的治疗方案，宫腹腔镜既可降低子宫穿孔的几率又可以发现盆腔子宫内膜异位症。术后配合使用短期的雌激素有利于子宫内膜的修复，增加受孕率，也有促进盆腔子宫内膜异位病灶的复发的危险，但总的疗效尚满意。

Clinical Therapy and Outcome of Pregnancy of Uterus Septus Patients Accompanying with Endometriosis

[Objective]To investigate the therapy after laparoscopy and hysteroscopy in uterus septus patients accompanying with endometriosis. [Methods]The clinical data of 40 patients with uterus septus accom-panying with endometriosis enrolled in gynecologic ＆ obstetrics department of Shenzhen hospital of Beijing U niversity from Jan. 2002 to Jan. 2008 were analyzed retrospectively. [Results]All the 40 uterus septus pa- tients were all accompanied with endometriosis. Their clinical symptom all showed infertility. All patients were treated by hysteroscopy combined with laparoscopy. The bysteroscopy revealed 13 patients with complete uterus septus and 27 patients with incomplete uterus septus. The endometriosis were all remained stage I-Ⅱ according to ASF r staging. All patients were treated by estrogen for three months and were put in IUD for 2-4 months. By following-up, 21 patients were pregnant and 16 patients labored. The rate of pregnant was 52.5%. [Conclusion]The uterus septus patients are easy to accompany with endometriosis and should be diag- nosed and treated by surgery early. Hysteroscopy combined with laparoscopy is the optimal surgery choice for that can reduce the probability of uterine perforation and find endometriosis early. Treatment with estrogen af ter surgery is beneficial to the recovery of endometrial, but is harmful to the pelvic endometriosis. If necessa ry, second laparoscopy should be done to destroy the endometriosis lesions and the treatment result is satisfac- tory.