子宫纵隔宫腔镜手术后的生殖结局：剪刀法还是电凝法？

Reproductive outcome after operative hysteroscopy for uterine septum: scissors or diathermy?

作者信息

Daniilidis Angelos, Kalpatsanidis Antonis, Kalkan Uzeyir, Kasmas Stamatis, Pados George, Angioni Stefano

机构信息

Second Department of Obstetrics and Gynecology, School of Medicine, Hippokration Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece.

First Department of Obstetrics and Gynecology, School of Medicine, Papageorgiou Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece.

出版信息

Minerva Ginecol. 2020 Feb;72(1):36-42. doi: 10.23736/S0026-4784.20.04444-5.

DOI:10.23736/S0026-4784.20.04444-5

PMID:32153162

Abstract

INTRODUCTION

Hysteroscopic septoplasty is a safe and routinely used procedure for the treatment of septate uterus. The aim of this paper is to determine which hysteroscopic technique (scissors, monopolar/bipolar diathermy) is superior for post-treatment reproductive outcome.

EVIDENCE ACQUISITION

Two different hysteroscopic septoplasty instruments (scissors and monopolar/bipolar diathermy) were compared, focusing on the pregnancy outcome. In addition, all published studies and reviews regarding pregnancy outcomes that occurred after operative hysteroscopy using different techniques (bipolar, monopolar electrodes, resectoscope, VERSAPOINT™ [Ethicon LLC] and scissors) were reviewed. Dichotomous analysis, with use of the Mantel-Haenszel method, was performed for all five outcomes, with fixed effect analysis model and odds ratio (OR) as the effect measure. Analysis details included totals and subtotals with 95% confidence interval. The Multinomial CI package for the R statistical language was also used.

EVIDENCE SYNTHESIS

Out of 26 full-text articles available in the literature, two studies were finally selected as eligible, with a total number of 125 patients. Pregnancy rate for scissors was 88.8% and for resectoscope was 75.6% (OR: 2.13, I2=29%; P=0.23). Delivery rate for scissors was 78.1% and for resectoscope was 75.0% (OR: 1.29, I2=0%; P=0.53). Miscarriage rate for scissors was 21.8% and for resectoscope was 27.1% (OR: 0.78, I2=0%; P=0.53). Preterm delivery rate for scissors was 6.2% and for resectoscope was 6.7% (OR: 0.85, I2=0%; P=0.94). Term delivery rate for scissors was 71.8% and for resectoscope was 66.1% (OR: 1.32, I2=0%; P=0.47). The lack of evidence in literature regarding the potential influence in the reproductive outcome of the instrument used when performing a hysteroscopy to treat a septate uterus became radically clear.

CONCLUSIONS

No statistically significant differences were observed in reproductive outcomes between women treated for septate uterus using resectoscope or scissors.

摘要

引言

宫腔镜子宫中隔切除术是治疗子宫中隔的一种安全且常用的手术。本文旨在确定哪种宫腔镜技术（剪刀、单极/双极电凝）在治疗后的生殖结局方面更具优势。

证据获取

比较了两种不同的宫腔镜子宫中隔切除器械（剪刀和单极/双极电凝），重点关注妊娠结局。此外，还回顾了所有已发表的关于使用不同技术（双极、单极电极、电切镜、VERSAPOINT™[Ethicon LLC]和剪刀）进行宫腔镜手术后妊娠结局的研究和综述。对所有五项结局采用Mantel-Haenszel方法进行二分法分析，采用固定效应分析模型，以比值比（OR）作为效应量。分析细节包括总数和小计以及95%置信区间。还使用了R统计语言的多项置信区间包。

证据综合

在文献中可获得的26篇全文文章中，最终选择了两项研究作为合格研究，共有125名患者。剪刀组的妊娠率为88.8%，电切镜组为75.6%（OR：2.13，I²=29%；P=0.23）。剪刀组的分娩率为78.1%，电切镜组为75.0%（OR：1.29，I²=0%；P=0.53）。剪刀组的流产率为21.8%，电切镜组为27.1%（OR：0.78，I²=0%；P=0.53）。剪刀组的早产率为6.2%，电切镜组为6.7%（OR：0.85，I²=0%；P=0.94）。剪刀组的足月分娩率为71.8%，电切镜组为66.1%（OR：1.32，I²=0%；P=0.47）。关于宫腔镜治疗子宫中隔时所用器械对生殖结局的潜在影响，文献中缺乏证据这一点变得非常明显。