Kupesic S
Department of Obstetrics and Gynecology, Medical School University of Zagreb, Sveti Duh Hospital, Croatia.
Ultrasound Obstet Gynecol. 2001 Oct;18(4):387-400. doi: 10.1046/j.0960-7692.2001.00539.x.
The purpose of this review article was to analyze the literature on the prevalence, diagnosis and treatment of the congenital uterine anomalies and to discuss current dilemmas on their influence on reproductive outcome. Congenital uterine anomalies are commonly associated with repeated pregnancy failure, in particular an increased risk of first- and second-trimester miscarriages and preterm delivery. Recent reports on two-dimensional and three-dimensional transvaginal ultrasound and saline contrast sonohysterography appear promising for diagnosis and classification of congenital uterine anomalies. The ability to visualize both the uterine cavity and the fundal uterine contour on a three-dimensional scan facilitates the diagnosis of uterine anomalies and enables differentiation between septate and bicornuate uteri. Color Doppler ultrasound allows visualization of intraseptal vascularity and may help in distinguishing the avascular from the vascular septum. Less connective tissue in the septum may result in poor decidualization and placentation, while an increased amount of muscle tissue in the septum can cause miscarriage by the production of local uncoordinated myometrial contractility. Hysteroscopic septum excision is an effective procedure which improves live-birth rates. Because of its simplicity, minimal invasiveness, low morbidity and low cost, a more liberal approach to the treatment of uterine anomalies is being advocated.
这篇综述文章的目的是分析关于先天性子宫异常的患病率、诊断和治疗的文献，并讨论当前关于其对生殖结局影响的困境。先天性子宫异常通常与反复妊娠失败相关，尤其是孕早期和孕中期流产以及早产风险增加。最近关于二维和三维经阴道超声以及盐水造影超声子宫输卵管造影的报告在先天性子宫异常的诊断和分类方面似乎很有前景。在三维扫描中可视化子宫腔和子宫底部轮廓的能力有助于子宫异常的诊断，并能够区分纵隔子宫和双角子宫。彩色多普勒超声可以显示纵隔内的血管，可能有助于区分无血管纵隔和血管性纵隔。纵隔中结缔组织较少可能导致蜕膜化和胎盘形成不良，而纵隔中肌肉组织增多可通过产生局部不协调的子宫肌层收缩导致流产。宫腔镜纵隔切除术是一种有效的手术方法，可提高活产率。由于其操作简单、微创、发病率低和成本低，目前提倡对子宫异常采取更宽松的治疗方法。
