Detti Laura, Hickman Holly, Levi D'Ancona Roberto, Wright Alicia W, Christiansen Mary E
University of Tennessee Health Science Center, Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Memphis, Tennessee, USA.
J Ultrasound Med. 2017 Apr;36(4):757-765. doi: 10.7863/ultra.15.07073. Epub 2016 Dec 10.
Existing recommendations warrant correction of uterine subseptations longer than 10 mm. We assessed whether a different subseptation length is indicated for intervention by evaluating the postoperative decrease in cavity width.
We conducted a prospective controlled cohort study at a university center. Healthy women and women with subseptations were evaluated with three-dimensional ultrasound before and after undergoing surgical resection of uterine subseptations by hysteroscopy. Measurement of the subseptum's length and width, and total cavity width, were obtained in both groups of women. We created a receiver operating characteristic curve using 7-mm cavity postoperative width change as the reference variable, and subseptation length as the outcome variable. Identifying a new subseptation length that warrants surgical intervention.
Seventy-six women with subseptations and 77 with healthy uteri were included in the study. In the subseptate group, 50 had a subseptum less than 10 mm, and 26 were greater than 10 mm. Uterine and uterine cavity widths were significantly greater than in healthy women. The postoperative cavity width (28 ± 0.9 mm) was correlated with the preoperative subseptum length (R = 0.42; P = .016) and width (R = 0.54; P = .001) and was similar to healthy uteri. The receiver operator characteristic curve identified 5.9 mm (sensitivity = 100%, specificity = 41.4%) as a new threshold length of subseptation, which shows a postoperative cavity adjustment comparable to a subseptation greater than 10 mm.
The relevance of subseptations shorter than 10 mm is currently undetermined and underestimated. Our data indicate a new subseptation cutoff length with postoperative remodeling and statistical relevance similar to longer subseptations. We propose a revision of the recommendations for surgical correction to include the objectively obtained subseptation length greater than or equal to 5.9 mm.
现有建议要求矫正长度超过10毫米的子宫纵隔。我们通过评估术后宫腔宽度的减小情况，来确定是否需要针对不同的纵隔长度进行干预。
我们在一所大学中心进行了一项前瞻性对照队列研究。对健康女性和患有纵隔的女性在宫腔镜手术切除子宫纵隔前后进行三维超声评估。两组女性均测量了纵隔的长度和宽度以及总宫腔宽度。我们以术后7毫米的宫腔宽度变化作为参考变量，纵隔长度作为结果变量，创建了一条受试者工作特征曲线，以确定需要手术干预的新的纵隔长度。
76名患有纵隔的女性和77名子宫健康的女性纳入了研究。在纵隔组中，50名女性的纵隔长度小于10毫米，26名女性的纵隔长度大于10毫米。子宫和宫腔宽度明显大于健康女性。术后宫腔宽度（28±0.9毫米）与术前纵隔长度（R = 0.42；P = 0.016）和宽度（R = 0.54；P = 0.001）相关，且与健康子宫相似。受试者工作特征曲线确定5.9毫米（敏感性 = 100%，特异性 = 41.4%）为纵隔的新阈值长度，其术后宫腔调整情况与大于10毫米的纵隔相当。
目前，长度小于10毫米的纵隔的相关性尚未确定且被低估。我们的数据表明，新的纵隔截断长度在术后重塑和统计学相关性方面与较长的纵隔相似。我们建议修订手术矫正的建议，将客观测量得到的大于或等于5.9毫米的纵隔长度纳入其中。
