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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。
Objective To investigate the effect of hysteroscopic resection of uterus on uterine cervix, double cervix and vaginal mediastinum. Methods From September 2004 to August 2013, 64 patients with complete septal, double cervix and vaginal mediastinum in Affiliated Obstetrics and Gynecology Hospital of Zhejiang University Medical College underwent hysteroscopic resection of the uterus and vaginal mediastinal resection , Divided into repeated abortion group (26 cases) and infertility group (38 cases), telephone or outpatient follow-up pregnancy outcome. Results 25 cases of recurrent miscarriage pregnancy, cumulative pregnancy 31 times, the spontaneous abortion rate decreased from 83.1% (54/65) preoperative to 41.9% (13/31), full-term, preterm and live birth rates were 35.5 (11/31), 19.3% (6/31) and 54.8% (17/31), respectively, which were significantly different from those before operation (P <0.05) (18/38), of whom 12 had full-term delivery. A total of 32 preterm births and full term births were reported in this study. The rate of preterm birth was 28.1% (9/32) and the full term birth rate was 71.9% (23/32). The placenta adhesion, the incidence of implantation 21.9% (7/32), the incidence of postpartum hemorrhage 25.0% (8/32). Conclusion Hysteroscopic resection of the uterus resection can improve the pregnancy rate and reproductive prognosis of patients with complete uterine cervix, double cervix and vaginal mediastinum.