Wang Xi, Hou Haiyan, Yu Qi
Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences.
Department of Obstetrics and Gynecology, Peking University First Hospital.
Medicine (Baltimore). 2019 Jul;98(30):e16623. doi: 10.1097/MD.0000000000016623.
Different sizes of uterine septum between infertile women and patients with abortions may have a clinical relevance in reproductive performance after surgery. This study aimed to assess if the fecundity of women after surgical correction of the uterine septum is associated with septum size.A retrospective, single-center, cohort study was conducted in Peking Union Medical College Hospital using patients aged between 21 and 37 years. Hysteroscopic metroplasty was performed on 121 patients with a uterine septum. The septum size was assessed by ultrasonography and hysteroscopy. The subjects were divided into 3 groups: Group A consisted of 35 women with complete uterine septum (mean ± standard deviation (SD) age 28.29 ± 3.53; group B consisted of 48 women with uterine septum >2.5 cm (mean ± SD age 28.85 ± 3.63); and group C consisted of 48 women with uterine septum ≤2.5 cm (mean ± SD age 28.79 ± 3.74). Age and body mass index (BMI) were not significantly different among the 3 groups.No serious hysteroscopic complications occurred. However, uterine septa were observed in 4 cases after surgery and 6 cases of intrauterine adhesions were observed after long-term follow-up. The abortion rate decreased, and term delivery rate increased significantly in the 3 groups after hysteroscopic metroplasty. The infertility rate was significantly lower in group C after surgery. However, no significant difference was observed in the infertility rate between groups A and B. The recurrent abortion rate was significantly lower in group A than in groups B and C before surgery. After surgery, the infertility rate was significantly higher in group A than in group B (28.57% and 10.53%, respectively; P = .048). After at least 12-months of follow-up, the pregnancy rate in group A was significantly lower than that in group C (71.43% and 89.47%, respectively; P = .048).Uterine septum resection improves obstetrical outcomes. After surgery, the infertility rate was significantly higher in patients with complete uterine septum than in those with a large partial uterine septum, and the pregnancy rate in patients with complete uterine septum was lower than that in the patients with a small partial uterine septum.
不孕女性与流产患者的子宫纵隔大小不同，这可能对手术后的生殖性能具有临床意义。本研究旨在评估子宫纵隔手术矫正后女性的生育能力是否与纵隔大小有关。
在北京协和医院对年龄在21至37岁之间的患者进行了一项回顾性、单中心队列研究。对121例子宫纵隔患者进行了宫腔镜子宫成形术。通过超声检查和宫腔镜检查评估纵隔大小。受试者分为3组：A组由35例完全性子宫纵隔女性组成（平均±标准差（SD）年龄28.29±3.53）；B组由48例子宫纵隔>2.5 cm的女性组成（平均±SD年龄28.85±3.63）；C组由48例子宫纵隔≤2.5 cm的女性组成（平均±SD年龄28.79±3.74）。3组之间的年龄和体重指数（BMI）无显著差异。
未发生严重的宫腔镜并发症。然而，术后4例观察到子宫纵隔，长期随访后观察到6例宫腔粘连。宫腔镜子宫成形术后3组的流产率降低，足月分娩率显著提高。术后C组的不孕率显著降低。然而，A组和B组之间的不孕率无显著差异。术前A组的复发性流产率显著低于B组和C组。术后，A组的不孕率显著高于B组（分别为28.57%和10.53%；P = 0.048）。至少随访12个月后，A组的妊娠率显著低于C组（分别为71.43%和89.47%；P = 0.048）。
子宫纵隔切除术可改善产科结局。术后，完全性子宫纵隔患者的不孕率显著高于部分性大子宫纵隔患者，完全性子宫纵隔患者的妊娠率低于部分性小子宫纵隔患者。
