University Hospital, Obstetrics and Gynecology, 16 Boulevard De, Bulgaria; Safe CIC 1414 Thematic Team, University Hospital Rennes, Rennes, France.
University Hospital, Obstetrics and Gynecology, 16 Boulevard De, Bulgaria; Safe CIC 1414 Thematic Team, University Hospital Rennes, Rennes, France.
Eur J Obstet Gynecol Reprod Biol. 2020 Apr;247:232-237. doi: 10.1016/j.ejogrb.2020.01.028. Epub 2020 Feb 1.
To describe symptoms and fertility and quality of life outcomes after isthmocele surgery.
We conducted a retrospective study on from January 2012 to December 2017 in two tertiary referral centers in Rennes (France). All the patients diagnosed with isthmocele and operated were included. They all underwent isthmocele surgery by hysteroscopy, vaginal way or laparotomy.
The following data were collected: surgical procedure, symptoms and fertility before and after surgery, patient satisfaction about the surgery, and quality of life after surgery. Eighteen patients were included. The mean duration of follow-up was 15 months. Surgical procedures consisted of hysteroscopy (n = 5/18, 27.8%), vaginal surgery (n = 8/18, 44.4%) and laparotomy (n = 5/18, 27.8%). Surgical indications were: secondary infertility (n = 10/18, 55 %), pelvic pain (n = 5/18, 28%) and abnormal uterine bleeding (n = 3/18, 17%). Among patients with abnormal uterine bleeding, improvement was obtained after hysteroscopy, laparotomy and vaginal surgery for 83.3%, 75% and 50%, respectively. Among those with pelvic pain, improvement was obtained after hysteroscopy, laparotomy and vaginal surgery for 80%, 81% and 66%, respectively. One patient (1/18, 5.5%) had post-operative complication. Of the 12 patients who wished to conceive eleven pregnancies were obtained (91.7%). Of the 10 patients with secondary infertility, six became pregnant (60%). Five pregnancies (5/11, 45.4%) were carried to full term, including four in patients whose surgical indication was infertility. Among these, one patient had a vaginal delivery (after vaginal surgery) without obstetric complication. All patients operated on by hysteroscopy would recommend this surgery versus 75% of patients with vaginal surgery and 60% of patients with laparotomy (p = 0.24). Pain and quality-of-life scores were comparable between the three groups.
Isthmocele surgery is effective for abnormal uterine bleeding, pain and infertility regardless of the surgical route.
描述息室手术后的症状、生育能力和生活质量结果。
我们在雷恩的两家三级转诊中心（法国）进行了一项回顾性研究。纳入所有诊断为息室并接受手术的患者。所有患者均行宫腔镜、阴道或剖腹手术。
收集了以下数据：手术过程、手术前后的症状和生育能力、患者对手术的满意度以及手术后的生活质量。共纳入 18 例患者，平均随访时间为 15 个月。手术方式包括宫腔镜（n=5/18，27.8%）、阴道手术（n=8/18，44.4%）和剖腹手术（n=5/18，27.8%）。手术指征为：继发不孕（n=10/18，55%）、盆腔痛（n=5/18，28%）和异常子宫出血（n=3/18，17%）。在异常子宫出血患者中，宫腔镜、剖腹手术和阴道手术的改善率分别为 83.3%、75%和 50%。在盆腔痛患者中，宫腔镜、剖腹手术和阴道手术的改善率分别为 80%、81%和 66%。1 例（1/18，5.5%）患者术后出现并发症。12 例有生育要求的患者中，11 例受孕（91.7%）。10 例继发不孕患者中，6 例妊娠（60%）。5 例（5/11，45.4%）妊娠足月，其中 4 例手术指征为不孕。其中 1 例（经阴道手术）阴道分娩，无产科并发症。接受宫腔镜手术的患者中，所有患者均推荐该手术，阴道手术的患者中有 75%，剖腹手术的患者中有 60%（p=0.24）。三组患者的疼痛和生活质量评分无差异。
息室手术对异常子宫出血、疼痛和不孕均有效，与手术途径无关。
