Vigoureux Solène, Fernandez Hervé, Capmas Perrine, Levaillant Jean-Marc, Legendre Guillaume
Bicêtre University Hospital Assistance Publique-Hôpitaux de Paris, Le Kremlin Bicêtre, France; INSERM UMRS 1018, CESP Centre for Research in Epidemiology and Population Health, Paris-Sud University, Le Kremlin Bicêtre, France.
Bicêtre University Hospital Assistance Publique-Hôpitaux de Paris, Le Kremlin Bicêtre, France.
J Minim Invasive Gynecol. 2016 Jan;23(1):78-83. doi: 10.1016/j.jmig.2015.08.882. Epub 2015 Aug 28.
To compare the rates of re-intervention, and immediate and later complications associated with abdominal ultrasound-guided versus unguided hysteroscopic metroplasty in the surgical repair of European Society of Human Reproduction and Embryology/European Society for Gynecological Endoscopy class II intrauterine septa.
We performed a large observational retrospective study (Canadian Task Force Classification II-2) in a selection of patients who underwent metroplasty in a tertiary university center between 2009 and 2013.
A total of 108 patients were included in the study.
Patients were categorized as having abdominal ultrasound-guided metroplasty (n = 46) or unguided metroplasty (n = 62).
Data were collected with regard to medical and reproductive histories, diagnosis of septate uterus, surgical procedures, and complications. Using these data, the need for re-intervention and complication rates were compared between groups. Statistical analysis was performed using Fisher's exact test and Student's t-test. The characteristics of the 2 groups were comparable. A persistent septum of >10 mm, defined by 3-dimensional ultrasound hysterosonography, with a need for re-intervention, was found in 16 patients (39.0 %) in the unguided group versus 7 patients (18.4 %) in the ultrasound guidance group (p = .04). Risk of a persistent septum after resection (>10 mm) was reduced with ultrasound guidance (odds ratio = 0.35; 95% confidence interval 0.13-0.99). Two uterine perforations occurred in our series; both were in the unguided group.
A systematic abdominal ultrasound-guided metroplasty by hysteroscopy seems to reduce the rates of re-intervention.
比较腹部超声引导与非超声引导的宫腔镜子宫中隔成形术在修复欧洲人类生殖与胚胎学会/欧洲妇科内镜学会II类宫腔中隔时再次干预的发生率以及近期和远期并发症。
我们对2009年至2013年间在一所三级大学中心接受子宫中隔成形术的患者进行了一项大型观察性回顾性研究（加拿大工作组分类II-2）。
共有108例患者纳入本研究。
患者被分为接受腹部超声引导子宫中隔成形术组（n = 46）和非超声引导子宫中隔成形术组（n = 62）。
收集患者的医疗和生殖史、子宫中隔诊断、手术过程及并发症等数据。利用这些数据比较两组再次干预的必要性和并发症发生率。采用Fisher精确检验和Student t检验进行统计分析。两组患者特征具有可比性。经三维超声子宫造影术定义，需要再次干预的持续性中隔>10 mm，在非超声引导组16例患者（39.0%）中发现，而在超声引导组7例患者（18.4%）中发现（p = 0.04）。超声引导降低了切除后持续性中隔（>10 mm）的风险（优势比 = 0.35；95%置信区间0.13 - 0.99）。本系列研究中发生了2例子宫穿孔；均发生在非超声引导组。
宫腔镜下系统性腹部超声引导子宫中隔成形术似乎可降低再次干预的发生率。
