目的探讨子宫中隔影响妊娠的机理及宫腔镜子宫中隔切除术(TCRS)的生殖预后影响。方法选取2011年10月~2014年10月入住华中科技大学同济医学院附属普爱医院的80例子宫中隔患者作为研究组,另选取同期于该院进行检查的80例正常孕妇作为对照组。研究组采用TCRS进行治疗,分析手术情况、研究组TCRS手术前后妊娠情况、两组产科情况与分娩方式、研究组中隔肌层与子宫肌层的组织结构变化及患者手术前后生活质量各维度评分。结果无子宫大出血、子宫穿孔、水中毒以及脏器损伤等并发症发生;手术时间为17~40 min,平均(32.08±4.39)min;术中出血量为6.50~21.00 ml,平均(12.20±2.17)ml;术中膨宫液用量为1 000~3 000 ml,平均(1 432.30±55.72)ml;住院时间为4~7天,平均(5.82±0.17)天;研究组患者手术前后自然流产率、足月妊娠率及总活产分娩率比较,差异均有相关性(P=0.000);对照组与研究组TCRS术后分娩患者在早产、胎儿窘迫、臀位、胎膜早破、足月低体重儿及围产儿死亡方面比较差异均无统计学意义(P>0.05),而两组在剖宫产率方面比较,差异有统计学意义(P<0.05);患者术后量表各维度评分均显著高于术前(P<0.05)。结论中隔组织与子宫肌层的组织形态和超微结构异常是导致流产或不孕的原因,TCRS可明显改善不孕患者的生殖预后,不增加孕期并发症,不影响胎儿发育。 Objective To investigate the mechanism of uterine septum affecting pregnancy and reproductive prognosis of hysteroscopic resection of uterus (TCRS). Methods Eighty female patients with uterine septum admitted to Tongji Medical College Affiliated to Tongji Medical College of Huazhong University of Science and Technology from October 2011 to October 2014 were enrolled in this study. Eighty normal pregnant women who were checked in the same hospital during the same period were selected as the control group. The study group was treated with TCRS, the operation condition was analyzed, the pregnancy status before and after TCRS operation, the obstetric condition and mode of delivery in the two groups, the histological changes of the septum and myometrium in the study group and the scores of quality of life before and after operation . Results No complications such as uterine bleeding, uterine perforation, water poisoning and organ injury occurred. The operation time ranged from 17 to 40 minutes (mean, 32.08 ± 4.39) min. The intraoperative blood loss was 6.50-21.00 ml, with an average of 12.20 ± 2.17 ) ml. The intraoperative volume of uterine fluid was 1 000-3 000 ml (mean 1 432.30 ± 55.72) ml. The length of hospital stay was 4-7 days (5.82 ± 0.17) days. The spontaneous abortion rate , Full-term pregnancy rate and total live birth rate were compared (P = 0.000); control group and study group TCRS postpartum patients with preterm birth, fetal distress, breech, premature rupture of membranes, full-term There was no significant difference in low birth weight infants and perinatal death (P> 0.05), while there was significant difference between the two groups in cesarean section rate (P <0.05). The patients’ The score was significantly higher than preoperative (P <0.05). Conclusion Tissue morphology and ultrastructural abnormalities of septum and myometrium are the causes of miscarriage or infertility. TCRS can significantly improve the reproductive prognosis of infertile patients without increasing complications during pregnancy and without affecting fetal development.