Gubbini Giampietro, Di Spiezio Sardo Attilio, Nascetti Daniela, Marra Elena, Spinelli Marialuigia, Greco Elena, Casadio Paolo, Nappi Carmine
Department of Obstetrics and Gynaecology, Hospital Madre Fortunata Toniolo, Bologna, Italy.
J Minim Invasive Gynecol. 2009 Sep-Oct;16(5):554-61. doi: 10.1016/j.jmig.2009.06.002.
To produce and validate a simple, systematic and reproducible subclassification system for uterine anomalies previously classified by the American Ferility Society as Class V and VI to achieve a precise definition of each uterine anomaly, confirm the feasibility and safety of surgical correction of the anomalies, determine the type of hysteroscopic treatment, and provide a standard by which patient selection, treatment, and reproductive outcomes can be compared between centers.
Descriptive study (Canadian Task Force Classification III).
Department of obstetrics and gynecology of a private clinic (hospital).
Eighty-nine patients undergoing office hysteroscopy to assess partial or complete "double" uterine cavity.
All patients underwent 3-dimensional ultrasound. Data from hysteroscopy and untrasonography were combined to produce a geometric model comprising uterine septum length (Z variable) and fundus depth (Y variable) through which a new subclassification of the uterine anomalies was elaborated.
One patient with a bicornuate uterus detected at ultrasonography was excluded from the study. The remaining 88 patients were classified according to our subclassification system. Seventy-three patients categorized as having Z 2 cm or greater (septum intersecting one-third of the uterine cavity or more) and Y more than 0 cm (normal or straight uterine fundus) underwent resectoscopic metroplasty without laparoscopic control. Twelve patients categorized as A1 (normal uterine fundus and septum < or =0.5 cm) underwent office metroplasty. Two patients categorized as B1 (straight fundus and septum < or =0.5 cm) and 1 categorized as C1 (concave fundus and septum < or =0.5 cm) were not considered candidates for surgery. Second-look hysteroscopy confirmed complete removal of the septum in the 12 patients who underwent office metroplasty (100%) and in 70 of 73 patients (96%) who underwent resectoscopic metroplasty. Comparison of these data with data retrospectively obtained in 596 women who had undergone traditional resectoscopic metroplasty under laparoscopic control did not demonstrate any significant difference in success and complication rates.
Our outpatient subclassification system may address a precise diagnosis and a thorough categorization of patients with a partial or complete double uterine cavity, enabling safe and effective metroplasty without use of laparoscopy.
制定并验证一种简单、系统且可重复的子宫异常亚分类系统，该系统针对先前被美国生育协会分类为V类和VI类的子宫异常，以实现对每种子宫异常的精确定义，确认子宫异常手术矫正的可行性和安全性，确定宫腔镜治疗的类型，并提供一个标准，通过该标准可在各中心之间比较患者选择、治疗及生殖结局。
描述性研究（加拿大工作组分类III级）。
一家私立诊所（医院）的妇产科。
89例接受门诊宫腔镜检查以评估部分或完全“双”子宫腔的患者。
所有患者均接受三维超声检查。将宫腔镜检查和超声检查的数据相结合，生成一个包含子宫纵隔长度（Z变量）和宫底深度（Y变量）的几何模型，据此制定了一种新的子宫异常亚分类。
一名超声检查发现双角子宫的患者被排除在研究之外。其余88例患者根据我们的亚分类系统进行分类。73例被归类为Z≥2cm（纵隔相交子宫腔三分之一或更多）且Y>0cm（正常或直的子宫底）的患者在无腹腔镜监测的情况下接受了宫腔镜子宫成形术。12例被归类为A1（正常子宫底且纵隔≤0.5cm）的患者接受了门诊子宫成形术。2例被归类为B1（直的子宫底且纵隔≤0.5cm）和1例被归类为C1（凹的子宫底且纵隔≤0.5cm）的患者未被视为手术候选者。二次宫腔镜检查证实，接受门诊子宫成形术的12例患者（100%）以及接受宫腔镜子宫成形术的73例患者中的70例（96%）的纵隔已完全切除。将这些数据与596例在腹腔镜监测下接受传统宫腔镜子宫成形术的女性患者回顾性获得的数据进行比较，未发现成功率和并发症发生率有任何显著差异。
我们的门诊亚分类系统可能有助于对部分或完全双子宫腔患者进行精确诊断和全面分类，从而在不使用腹腔镜的情况下实现安全有效的子宫成形术。
