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目的探讨子宫纵隔合并流产后轻度宫腔粘连改善妊娠结局的诊治方法。方法回顾性分析福建省妇幼保健院2012—2015年收治的不完全子宫纵隔合并轻度宫腔粘连病例。术前经阴道B超、三维彩超、碘油造影及宫腔镜联合诊断,联合B超行宫腔镜子宫纵隔切除术+粘连分离术治疗,术后电话随访生育结局。结果 62例不完全子宫纵隔合并宫腔粘连患者术前诊断符合率:子宫输卵管造影74.4%(32/43),经阴道B超21.0%(13/62),三维彩超75.8%(47/62),三维彩超联合宫腔镜检查100%。随访自然流产率由术前的62.9%下降至9.7%;不孕率由术前37.1%下降至16.1%;活产率由术前的9.7%上升至74.2%。结论宫腔镜联合三维彩超,可提高不完全子宫纵隔合并轻度宫腔粘连的诊断率;联合B超行宫腔镜纵隔切除术+粘连分离术直观、微创,是目前改善妊娠结局的最佳选择。
Objective To investigate the method of diagnosis and treatment of pregnancy after the mediastinal uterine adhesions combined with mild intrauterine adhesions. Methods We retrospectively analyzed the cases of incomplete uterine segment mediastinum combined with mild uterine adhesions admitted in Fujian Provincial Maternal and Child Health Hospital from 2012 to 2015. Preoperative transvaginal B-ultrasound, three-dimensional color Doppler ultrasonography, lipiodol and hysteroscopy combined diagnosis, combined with B-hysteroscopic hysteroscopic resection of the mediastinum + adhesions separation, postoperative telephone follow-up reproductive outcomes. Results The coincidence rate of preoperative diagnosis of 62 cases of incomplete uterine mediastinal adhesions was 74.4% (32/43), 21.0% (13/62) of vaginal ultrasonography, 75.8% (47/62) , Three-dimensional ultrasound combined hysteroscopy 100%. The follow-up rate of spontaneous abortion decreased from 62.9% preoperatively to 9.7%; the rate of infertility decreased from 37.1% to 16.1% preoperatively; and the live birth rate increased from 9.7% preoperatively to 74.2%. Conclusions Hysteroscopy combined with three-dimensional ultrasound can improve the diagnosis rate of incomplete uterine mediastinum combined with mild uterine adhesions combined with B-ultrasound hysteroscopic mediastinal resection combined with adhesion separation is intuitive and minimally invasive, is the best to improve pregnancy outcome select.