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目的探讨宫腔镜子宫中隔切除术(TCRS)对子宫中隔合并不孕症及复发性流产患者的治疗效果。方法选择2010年7月-2015年4月山西现代妇产医院收治子宫中隔合并不孕症或复发性流产患者21例,住院行TCRS,术毕宫腔内放置球囊导尿管或宫内节育器拟预防宫腔粘连,定时宫腔镜检查,明确有无宫腔粘连。术后门诊及电话随访8~24个月,确定妊娠及分娩情况。结果 TCRS后宫内放置球囊导尿管17例,术后1周宫腔镜检查8例,75.00%无宫腔粘连;术后1月宫腔镜检查5例,2例无宫腔粘连,2例见子宫内膜瘢痕,1例宫腔粘连;宫内放置节育器4例,75.00%无宫腔粘连。术后随访17例,占80.95%,妊娠率为82.35%,足月分娩率为58.82%,中期妊娠2例,早期妊娠1例,稽留流产1例。结论对于子宫中隔合并不孕症及复发性流产的患者,TCRS安全有效,多可获得满意的妊娠结局。术后宫腔内放置球囊导尿管或宫内节育器预防宫腔粘连的效果及差异不明显。
Objective To investigate the effect of hysteroscopic uterine septumctomy (TCRS) on the treatment of infertility with uterine septum and recurrent spontaneous abortion. Methods Select from July 2010 to April 2015 Shanxi modern maternity hospital for treatment of uterine septum with infertility or recurrent miscarriage in 21 patients, hospital TCRS, intraoperative intrauterine placement of the balloon catheter or intrauterine IUD to prevent intrauterine adhesions, regular hysteroscopy, clear whether intrauterine adhesions. Postoperative clinic and telephone follow-up of 8 to 24 months to determine the pregnancy and childbirth. Results There were 17 cases of balloon catheters placed in the posterior uterus of TCRS, 8 cases of hysteroscopy one week after operation, and no intrauterine adhesions were found in 75.00% of the cases. Hysteroscopy was performed in 5 cases in January, 2 cases without intrauterine adhesions and 2 cases See endometrial scar, 1 case of intrauterine adhesions; intrauterine placement of IUD in 4 cases, 75.00% without intrauterine adhesions. Postoperative follow-up 17 cases, accounting for 80.95%, the pregnancy rate was 82.35%, full-term delivery rate was 58.82%, 2 cases of interim pregnancy, early pregnancy in 1 case, missed abortion in 1 case. Conclusion For patients with uterine septum and infertility and recurrent spontaneous abortion, TCRS is safe and effective, and can obtain satisfactory pregnancy outcomes. Postoperative intrauterine placement of balloon catheter or intrauterine device to prevent intrauterine adhesions effect and the difference is not obvious.